081-PP02L023 ELO C_Disorders of the Pancreas _V 2.0_.pdf

DISORDERS OF THE PANCREAS 081‐NP02L023 ELO C · Version 2.0 Foundations and Adult Health Nursing, 8th ed., pp. 1702 & 1723‐1745 Introduction to Clinical Pharmacology 10th ed., Visovsky et.al, pp. 327‐345 TERMINAL LEARNING OBJECTIVE Explain safe and effective nursing care of a patient with diabetes m...

DISORDERS OF THE PANCREAS 081‐NP02L023 ELO C · Version 2.0 Foundations and Adult Health Nursing, 8th ed., pp. 1702 & 1723‐1745 Introduction to Clinical Pharmacology 10th ed., Visovsky et.al, pp. 327‐345 TERMINAL LEARNING OBJECTIVE Explain safe and effective nursing care of a patient with diabetes mellitus. ENABLING LEARNING OBJECTIVE Describe the etiology and pathophysiology, clinical manifestations, assessment, diagnostic tests, medical management, nursing interventions, patient teaching, and prognosis for the patient with a disorder of the pancreas.  PANCREAS: LOCATION AND FUNCTION Endocrine islets of Langerhans beta cells alpha cells Exocrine CHECK ON LEARNING Where is the pancreas located? CHECK ON LEARNING What is the function of the pancreas? CHECK ON LEARNING Insulin is produced by _____________? DIABETES MELLITUS  ETIOLOGY/PATHOPHYSIOLOGY Diabetes = sieve / siphon Mellitus= sweet / related to honey Absent or Deficiency of Insulin Two Main Types Type 1 Type 2 CAUSES OF TYPE 1 & TYPE 2 COMPLICATIONS  TYPE 1 DIABETES MELLITUS Progressive destruction Rapid Onset  TYPE 2 DIABETES MELLITUS Occurs after age 35 years‐old Overweight Do not know they have diabetes until later Decreased tissue response to insulin production of insulin abnormal hepatic regulation CHECK ON LEARNING What is the primary difference between Type 1 and Type II diabetes mellitus?  COMPARE AND CONTRAST DIABETES MELLITUS 1&2: CLINICAL MANIFESTATIONS 3 P’s most common Polydipsia Polyuria Polyphagia TYPE 1 DIABETES MELLITUS: ASSESSMENT SUBJECTIVE Polyphagia Polydipsia Polyuria OBJECTIVE Slow wound healing Frequent infections (UTI and Vaginal) Weight Type 1 = weight loss and muscle wasting Type 2 = obese CHECK ON LEARNING A 19‐year‐old woman seeks care because of excessive thirst, hunger, fatigue. She reports not being able to sleep at night for the past few weeks because of needing to go to the bathroom. What medical diagnosis is anticipated? CHECK ON LEARNING A 19‐year‐old woman seeks care because of excessive thirst, hunger, fatigue. She reports not being able to sleep at night for the past few weeks because of needing to go to the bathroom. What medical diagnosis is anticipated? What other clinical manifestations may the nurse want to assess? CHECK ON LEARNING The nurse is aware they the polydipsia and polyuria experienced by a patient with poorly controlled diabetes are caused primarily by which of the following? a. The release of ketones from cells during fat metabolism b. Fluid shifts resulting from osmotic effect of hyperglycemia c. Damage to the kidneys from exposure to high levels of glucose d. Changes in RBC’s resulting from attachment of excessive glucose to hemoglobin DIAGNOSTIC TESTS Random Blood Glucose >200 mg/dL Fasting blood Glucose 126 mg/dL or more Oral Glucose Tolerance Test Serum Insulin = Absent in Type1 Normal or High in Type 2 Postprandial Blood Glucose >160 mg/dL Glycosylated Hemoglobin (HB A1c) C‐peptide Test Urine Testing CHECK ON LEARNING Which patient needs to test the urine for ketones as part of self‐care management? a. Gestational diabetic who has started insulin b. Type II diabetic who is preparing to exercise c. Type I diabetic who has a febrile infection d. An older diabetic who cannot perform self‐monitored blood glucose tests  MEDICAL MANAGEMENT Goals Education Diet Meal planning Exercise Stress Management Medications Other Treatments (keep appointments For foot care, eye dr, etc.) CHECK ON LEARNING What should the nurse caution a type 1 about excessive exercise? a. It can increase the need for insulin and may result in hyperglycemia b. It can decrease the need for insulin and may result in hypoglycemia (correct) c. It can increase muscle bulk and may result in malabsorption of insulin d. It can decrease metabolic demand and may result in metabolic acidosis NURSING IMPLICATIONS CHECK ON LEARNING Why is special foot care so important in the diabetic patient? COMPLICATIONS OF DIABETES MELLITUS: DIABETIC COMA CAUSES DKA HHNC HYPOGLYCEMIA  COMPLICATIONS OF DIABETES MELLITUS: DIABETIC COMA CAUSES DKA HHNC HYPOGLYCEMIA  COMPLICATIONS OF DIABETES MELLITUS: DKA Occurs in Type 1 Diabetes Hunger is not present Kussmaul’s respirations Symptoms Early: Weakness Drowsiness Vomiting Dehydration Later Sweetish odor Hypotension Restlessness COMPLICATIONS OF DIABETES MELLITUS: DKA Insulin IV fluids Electrolyte (K+) Hourly glucose levels Management/ Treatment COMPLICATIONS OF DIABETES MELLITUS: HYPERGLYCEMIC HYPEROSMOLAR NONKETOTIC COMA (HHNC) Occurs in Type 2 Diabetes Onset – Day Symptoms Dehydration Normal respirations Lethargy Hunger is absent Blood glucose 600‐ 2000 mg/dL COMPLICATIONS OF DIABETES MELLITUS: HHNC Insulin IV fluids Electrolyte Hourly glucose levels Management/ Treatment COMPLICATIONS OF DIABETES MELLITUS: HYPOGLYCEMIA Below 60 mg/dL Overdose of insulin Overdose hypoglycemic agents Onset‐ minutes to hours Symptoms: Nervousness Tachycardia Diaphoresis Visual disturbances COMPLICATIONS OF DIABETES MELLITUS: HYPOGLYCEMIA Oral simple carbohydrate IV Glucagon Management/ Treatment  COMPLICATIONS OF DIABETES MELLITUS: INFECTIONS HYPERGLYCEMIA + KETONEMIA = DECREASE IN PHAGOCYTIC ACTION OF LEUKOCYTES DIABETIC KETOACIDOSIS FORMERLY CALLED DIABETIC COMA CHECK ON LEARNING What are the treatment goals in a patient experiencing diabetic ketoacidosis? CHECK ON LEARNING The nurse discovers the type 1 diabetic patient drowsy and tremulous, the skin is cool and moist, and the respirations are 32 and shallow. These are signs of: a) Hypoglycemic reaction; give 6 oz. of OJ b) Hyperglycemic reaction; give ordered regular insulin c) HHNK reaction; squeeze glucagon gel into the buccal space d) Hypoglycemic reaction; give ordered insulin COMPLICATIONS OF DIABETES MELLITUS: CHRONIC COMPLICATIONS CHECK ON LEARNING What is a long‐term complication of diabetes mellitus? a) Diverticulitis b) Renal failure c) Hypothyroidism d) Hyperglycemia  NURSING PROCESS Patient Problem Patient goals and expected Nursing Interventions Evaluation Outcomes Insufficient Knowledge: Self‐ 1. Patient will independently 1. Support patient as necessary to 1. Patient demonstrates safety in Injections, Self‐Monitoring of self‐administer insulin. self‐inject insulin drawing up and self‐administering Blood Glucose (SMBG), related to 2. Patient will perform SMBG 2. Observe patient’s skill in SMBG; insulin lack of exposure accurately. correct as necessary. 2. Patient demonstrates accuracy 3. Patient will use 3. Review with patient the effect of in SMBG. Measurements obtained by activity, dietary intake, and insulin on 3. Patient can verbalize the effect SMBG to achieve blood blood glucose. of activity, diet, and insulin on glucose less than 126 mg/dL. 4. Instruct patient on frequency and blood glucose. 4. Patient will be able to timing of SMBG. 4. Patient can recite signs and detect and treat 5. Review with patient signs and symptoms of hypoglycemia hypoglycemia symptoms and treatment measures. treatment to pursue. 6. Refer to dietitian for modification of diet necessary with insulin and for verification of diet knowledge.  NURSING PROCESS Patient Problem Patient goals and expected Nursing Interventions Evaluation Outcomes Compromised maintenance of 1. Patient will state at least 1. Teach patient effects of stress, 1. Patient has enrolled in an health, related to ineffective one change that will lack of exercise, and activity pattern exercise and weigh reduction coping skills improve blood glucose on blood glucose level. program to assist in achieving a control 2. Explore with patient willingness reasonable weight and and ability to change behaviors: beneficial exercise. sleep activity, coping, and exercise. Engage patient in mutual problem solving, refrain from prescribing. 3. Explore sources for long‐term support in learning more effective coping skills; suggest support groups.  For patient with DM  For weight loss and maintaining weight loss  Available at work in health service program SUMMARY OF MAIN POINTS Location and endocrine function of the pancreas. Pathophysiology of Type I and Type II Diabetes. Signs/symptoms of Diabetes. Diagnostic tests in diabetes management. Medical, nursing, and surgical management of diabetes Nursing Intervention and patient education of diabetes. Acute complications. Chronic Complications Nursing Process QUESTIONS?