Nursing Concepts in Health and Illness III

You People Have No Idea - Care Scenario Notes

• This document is study notes for a Nursing Concepts in Health and Illness III course at McMaster University, Fall 2021.
• It covers diabetes mellitus, including type 1 and type 2, gestational diabetes, prediabetes, and diagnostic studies.
• It also discusses collaborative care, drug therapy, including insulin regimens, oral agents, and noninsulin injectables, and monitoring blood glucose.
• Chronic complications of diabetes, such as macrovascular and microvascular complications, are discussed, including diabetic retinopathy, nephropathy, and neuropathy.
• Acute complications, such as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS) are discussed.
• Management of diabetes in children and adolescents, including education, glycemic targets, insulin therapy, and complications unique to pediatric populations.
• The role of the nurse in managing diabetes, and patient/family education are also highlighted.

Diabetes Mellitus

• A chronic multisystem disorder of glucose metabolism, related to insulin deficiency or impaired utilization.
• Current theories link causes to genetic, autoimmune, and environmental factors.

Type 1 Diabetes Mellitus

• Typically diagnosed before age 40, with 40% of cases diagnosed before 20 years old.
• Characterized by the body's own T cells attacking and destroying pancreatic cells, the source of insulin.
• Rapid-onset symptoms: polyuria, polydipsia, and polyphagia (caused by hyperglycemia).
• Requires insulin therapy to sustain life.
• Diabetic ketoacidosis (DKA) is a life-threatening complication without insulin.

Type 2 Diabetes Mellitus

• Accounts for over 90% of cases.
• Often associated with insufficient or poorly used insulin.
• Obesity, specifically abdominal and visceral adiposity, is the most significant risk factor.
• Symptoms are generally less acute than in type 1.
• Common symptoms include fatigue, recurrent infections, yeast infections, slow wound healing, and visual changes.

Prediabetes

• Blood glucose levels are higher than normal but not yet high enough for a diagnosis of diabetes.
• Individuals with prediabetes are at high risk for developing type 2 diabetes within 10 years.
• Preventive measures are crucial.

Gestational Diabetes

• Develops during pregnancy, typically screened for between 24-28 weeks gestation.
• Often resolves after pregnancy, but there is a higher risk of developing type 2 diabetes later in life.

Diagnostic Studies

• Fasting plasma glucose test
• Random plasma glucose test
• 2-hour oral glucose tolerance test
• A1C test

Collaborative Care

• Reducing symptoms and promoting well-being
• Preventing acute complications of hyperglycemia.
• Preventing/delaying long-term complications (macrovascular and microvascular.)

Drug Therapy: Insulin

• Exogenous insulin is needed when a patient has inadequate insulin production.
• Insulins are categorized as short-acting (bolus) and long-acting (basal).
• Bolus insulin targets postprandial hyperglycemia; basal insulin maintains background levels throughout the day.
• Several regimens are used depending on patient needs.

Oral Agents and Non-Insulin Injectable Agents

• Metformin is a common oral agent used for type 2 diabetes. Works by reducing glucose production in the liver.
• Sulfonylureas and Meglitinides increase insulin production from the pancreas.
• a-Glucosidase inhibitors slow carbohydrate absorption.
• Thiazolidinediones are effective for insulin resistance but have severe adverse effects.
• Dipeptidyl peptidase IV (DPP-4) inhibitors slow the degradation of GLP-1, resulting in improved glycemic control

This quiz covers essential topics in Nursing Concepts related to diabetes mellitus, including types 1 and 2, gestational diabetes, and prediabetes. It addresses collaborative care, drug therapies, and the management of chronic and acute complications of diabetes. The role of nursing in patient education and care for children and adolescents with diabetes is also discussed.