Concepts of Care for Patients with Diabetes Mellitus PDF

Chapter 56 Concepts of Care for Clients with Diabetes Mellitus  Concepts The priority concept in this chapter is Glucose Regulation The interrelated concepts in this chapter are Nutrition Tissue Integrity Sensory Perception Per...

Chapter 56 Concepts of Care for Clients with Diabetes Mellitus  Concepts The priority concept in this chapter is Glucose Regulation The interrelated concepts in this chapter are Nutrition Tissue Integrity Sensory Perception Perfusion Immunity Fluid and electrolyte Balance Acid–Base Balance  Incidence and Prevalence More than 37.3 million people in the U.S. living with DM, with 8.5 million undiagnosed 5.7 million adults in Canada  Diabetes Mellitus Pathophysiology Review Common, chronic complex disorder of impaired nutrient metabolism (especially glucose) Types – chapter focuses on Type 1 (TIDM) and Type 2 (T2DM) Glucose regulation and homeostasis Absence of insulin Acute and chronic complications Diabetic ketoacidosis (DKA)- body does not have enough insulin? HS? Hyperglycemia - rapid intake of at least 15 grams of simple sugar, 15 to 15, carbs every 15 mins Atherosclerosis is involved Increased risk for stroke blood flow to the kidneys to the eyes affects the central nervous system, double vision, kidneys- end stage chronic disease cognitive disfucntion so it affects everything Health promotion- exercise/eat well  Insulin Physiology Proinsulin, secreted by and stored in the beta cells of the islets of Langerhans in the pancreas, is transformed by the liver into active insulin. Insulin attaches to receptors on target cells, where it promotes glucose transport into the cells through the cell membranes.  Metabolic Syndrome Simultaneous presence of metabolic factors that increase risk for type 2 DM Abdominal obesity Hyperglycemia Hypertension Hyperlipidemia  Health Promotion/Disease Prevention Control of diabetes and its complications is major focus for health promotion activities Balanced diet Increase activity  Recognize Cues: Assessment History Risk factors and symptoms smoking alcohol hypertension stress type 1 is an autoimmune Laboratory assessment Glycosylated hemoglobin (A1C) they track the last 3 months average blood sugar, fasting, nothing to drink/eat after midnigh FBG Screening for diabetes- look at textbook fasting blood glucose level of… Ongoing assessment Metabolic syndrome simultaneously presence  Analyze Cues and Prioritize Hypotheses: Analysis The priority collaborative problems for patients with DM include: Potential for injury Potential for surgical complications Potential for injury Potential for kidney disease Potential for acute complications  Generate Solutions & Take Action: Planning and Implementation Preventing injury from hyperglycemia medications and depends on the cause and they are oral metformin is th most common one seen in hospitals Enhancing surgical recovery know how often they need surgery Preventing injury from peripheral neuropathy extensive education on foot care/mirror if they don’t have someone, fitted/proper shoes, skin/nail care, have a dietitian cut their toes as to prevent infection Reducing the risk for kidney disease- ace inhibitors/check urine for albumin smoking cessation, control of hypertension Preventing complications- eat healthy food and don’t further exacerbate- 2  Care Coordination and Transition Management Self-management education nutrition- what to eat/how much to eat, assess where the learning needs are in the patient, exercise to a good extent, properly taking their meds, support groups- people going through the same thing for tips and this helps with the meant health aspect, make lifestyle changes Home care management Evaluate Outcomes: Evaluation 1 2 3 4 5 Achieve blood Avoid acute and Recover from Remain free of Remain free of glucose control chronic surgery without injury kidney disease complications of complications- as to avoid diabetes- DKA, due to dialysis HSS nephropathy