Diabetes Mellitus: Types, Symptoms & Management

Role and Function of Insulin

• Insulin aids glucose movement into muscle and adipose tissues.
• Prevents fat breakdown and encourages glycogen storage in the liver.

Signs and Symptoms of Diabetes Mellitus

• Type 1 includes polyuria, polydipsia, polyphagia, weight loss, and ketoacidosis.
• Type 2 is often asymptomatic at first, links to obesity and insulin resistance.

Diabetes Mellitus: Types and Risk Factors

• Type 1 is autoimmune or idiopathic, marked by absolute insulin deficiency needing insulin injections.
• Type 2 links to obesity, sedentary habits, and family history.
• Gestational diabetes arises during pregnancy, heightening the risk of type 2.

Diabetes Management and Treatment

• Type 1 treatment involves insulin shots, blood glucose checks, and carb counting.
• Type 2 involves lifestyle changes like diet and exercise, oral hypoglycemic drugs, and insulin when needed.
• Weight loss and diet are key for type 2 management.

Hypoglycemia vs. Hyperglycemia

• Hypoglycemia (BG <70 mg/dL) leads to sweating, shakiness, confusion, dizziness, and tachycardia.
• Hyperglycemia symptoms include increased thirst, frequent urination, fatigue, and blurred vision.
• Diabetic Ketoacidosis (DKA) presents with fruity breath, Kussmaul respirations, dehydration, and ketonuria.
• Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS) involves severe hyperglycemia without ketosis, commonly in type 2.

Insulin Administration

• Absorption rates from fastest to slowest: Abdomen > Arms > Thighs > Hips.
• When mixing, draw up regular (clear) insulin before NPH (cloudy) insulin.
• Sliding scale insulin is for times of illness, stress, or surgery.

Oral Hypoglycemic Agents

• Metformin (Biguanide) lowers glucose production in the liver without causing hypoglycemia.
• Sulfonylureas (e.g., Glipizide) boost insulin release and carry a risk of hypoglycemia.

Diabetes Self-Care and Lifestyle

• Exercise considerations: Avoid injecting insulin into active muscles before working out and always have a quick glucose source handy.
• Foot care: Inspect feet daily, wash with lukewarm water, dry well, and trim nails straight across.
• Self-monitoring involves regular glucose checks, sticking to meds, and managing diet.

Endocrine Disorders Beyond Diabetes

• Acromegaly (Excess Growth Hormone) leads to enlargement of hands, feet, and facial features.
• Diabetes Insipidus (DI) leads to excess urination, dehydration, and low ADH levels.
• Cushing's Syndrome (Excess Cortisol) presents with moon face, buffalo hump, muscle weakness, and osteoporosis.
• Hyperaldosteronism includes hypertension, hypokalemia, and excessive thirst.

Nursing Management for Endocrine Disorders

• Pre and post-pituitary surgery care requires avoiding vigorous teeth brushing.
• For Cushing's Syndrome, symptoms improve after surgery, but it takes time.
• Hyperaldosteronism needs blood pressure control and electrolyte balance.

Hyperthyroidism & Thyroidectomy

• Hyperthyroidism shows increased metabolism, palpitation, fine tremors, and hyperalertness.
• Tapazole (Methimazole) can cause agranulocytosis; watch for sore throat and fever.
• Post-thyroidectomy watch for laryngeal nerve damage, thyroid storm, and hypocalcemia tetany.
• Check for blood pooling behind the neck to assess hemorrhage.
• Administer Lugol’s solution diluted in juice with a straw to prevent teeth staining.

Leukemia

• Survival rates are higher for children with ALL (~80%) than older adults with ANLL (~4-35%).
• Key issues include neutropenia (infection risk), anemia, and thrombocytopenia (bleeding).
• Diagnosis uses bone marrow biopsy.
• Common chemo drugs include Adriamycin (causes alopecia), Vincristine, Prednisone, and L-asparaginase.
• Hair returns in 3-6 months, sometimes darker or different.

Breast Cancer

• Risk factors include early menarche, late menopause, nulliparity, genetics, and increasing age.
• Protective factors involve exercise, breastfeeding, and prophylactic Tamoxifen.
• Lumpectomy + radiation has similar survival rates to radical mastectomy.
• Best time for Breast Self-Exam (BSE) is 7-8 days after menstruation ends or the same day monthly for postmenopausal women.
• Avoid applying creams, powders, or heat to radiated skin.

Radiation Therapy

• Common side effects include fatigue and malaise.
• External radiation does not make the patient radioactive.
• Radiation-induced thrombocytopenia needs monitoring for petechiae, ecchymosis, and epistaxis.

Cancer General Knowledge

• Carcinoma arises in epithelial cells (skin, organs).
• Sarcoma affects connective tissue (bones, muscles).
• Leukemia involves blood-forming tissues.
• Lymphoma affects the lymphatic system.
• A neutropenic diet restricts raw fruits/vegetables and undercooked meats, favoring cooked foods.
• Prostate cancer symptoms include dysuria, hematuria, back pain, and painful intercourse.

Stages of Grief (Kubler-Ross)

• Includes denial, anger, bargaining, depression, and acceptance.
• Denial involves shock or refusal to accept reality, such as seeking a second opinion.

Cancer & Tumor Markers

• Acid phosphatase is elevated in metastatic prostate cancer.
• Skin cancer risk factors: fair skin, prior skin cancer, and excessive sun exposure.
• Basal cell carcinoma is the most common, with a high recurrence rate but slow growth.

Psychosocial Responses to Terminal Illness

• Patients express unfinished business; making plans to visit places, reconnect with family before dying.

Intravenous (IV) Therapy & Fluid Management

• Normal Saline (0.9% NaCl) or Lactated Ringer’s are preferred for hypovolemia/blood loss.
• Isotonic IV solutions include 0.9% NaCl (Normal Saline) & Lactated Ringer’s.
• Infiltration presents as a cool, pale, swollen IV site with solution not infusing.

Electrolyte Imbalances & Acid-Base Balance

• Hypokalemia (Low K+ < 3.0 mEq/L) shows U waves on ECG.
• The extracellular buffer system is the quickest at maintaining acid–base balance.
• Hyponatremia (low sodium) causes lethargy, confusion, muscle weakness, and headache.
• Hypocalcemia (after blood transfusion) causes facial twitching (Chvostek’s sign).
• Metabolic alkalosis can cause hypokalemia.
• 4.5 lbs weight loss is about 2 liters of fluid loss.

Geriatrics & Fluid Balance

• Elderly at risk of dehydration due to less responsive thirst mechanism.

Hematology: Blood Types & Anemia

• Type O blood has no antigens on RBCs.
• Iron deficiency anemia is the most common type.
• Avoid milk with iron, as it hinders absorption.
• Parenteral iron is given IM via Z-track to prevent staining.
• Aplastic anemia can be caused by chloramphenicol.
• Pernicious anemia requires lifelong Vitamin B12 injections and increases the risk for gastric carcinoma.

Sickle Cell Disease Management

• Sickle Cell Trait (HbSA) means being an asymptomatic carrier who can pass the gene.
• Sickle Cell Crisis management needs oxygen, hydration, and pain management.
• Fluids should never be restricted during a sickle cell crisis.

Immunity & HIV/AIDS

• False negatives are possible with early HIV testing, before antibodies develop.
• Evaluate ART effectiveness 2-8 weeks post-treatment initiation.
• Zidovudine (AZT) can be taken without regard to meals.
• Kaposi’s sarcoma is the most common malignancy in AIDS.
• Common opportunistic infections include Pneumocystis pneumonia, TB, and C. difficile.
• Humoral immunity involves antibody production by B cells and triggers anaphylaxis, allergic hay fever, asthma, and bacterial invasion.
• Delayed hypersensitivity does not trigger humoral immunity; it is T-cell mediated.
• Protein deficiency affects immune function and infection resistance.
• Elevated eosinophils mark allergic reactions.

Emergency Nursing

• Anaphylactic shock’s first-line treatment is epinephrine IV or endotracheal route.
• Triage prioritizes by severity of illness, not patient details.
• Mass casualty triage: Red is most urgent, yellow urgent, green minor, black deceased.
• BLS starts with checking responsiveness.
• Airway management starts with a head-tilt, chin-lift.
• Chemical eye injuries need immediate irrigation with normal saline.
• For chemical skin exposure, flush immediately, without brushing off dry chemicals first.
• Near-drowning needs monitoring for respiratory complications.
• Heat stroke presents with confusion, tachycardia, and high fever (>105°F), treat with IV normal saline & cooling.
• Communication is key for transferring patients in emergency care.
• Action for an unresponsive client: Ensure adequate breathing.
• Knife wounds are classified as intentional.
• Laceration assessments require focused assessment.

Research & Measurement

• Error of measurement is the difference between a true and obtained score.
• Good test-retest candidates have traits that are stable over time.
• Key aspects of trustworthiness include Transferability, Confirmability, and Dependability.
• Stability is not an aspect of trustworthiness.
• Survey research involves new data collection.
• Quota sampling incorporates strata for proportional representation.