Diabetes Student Shell NUPD701 Module 10 PDF

Endocrine Disorders: Diabetes NUPD701: MODULE 10  1. Apply the nursing process to a client with: Diabetes Mellitus/Diabetic Ketoacidosis 2. Reflect and explore your personal values and beliefs in relation to the...

Endocrine Disorders: Diabetes NUPD701: MODULE 10  1. Apply the nursing process to a client with: Diabetes Mellitus/Diabetic Ketoacidosis 2. Reflect and explore your personal values and beliefs in relation to the metalanguage (metaparadigms) of nursing. Learning 3. Apply the metalanguage Objectives (metaparadigms) to a patient with: Diabetes Mellitus/Diabetic Ketoacidosis 4. Explore how all the patterns of knowing influence nurses and nursing practice. 5. Apply all the patterns of knowing to a patient with: Diabetes Mellitus/Diabetic Ketoacidosis DM- take away Similarities Treatments & Characteristic Types and Priorities of s of each Differences care Review: Insulin  Hormone produced by pancreas that exerts its effect on metabolism and cellular processes in all tissue and organs  Uses active transport to carry glucose into cells - * K+ goes with the insulin & glucose Main metabolic effects: 1. Simulates glucose uptake in skeletal and heart muscle 2. Suppresses liver production of glucose and low-density lipoproteins 1. When body is in starvation -> body release glucagon 3. Keeps blood glucose levels from getting too high and keeps lipids in normal range Review: Hyperglycemia  Acts as an Osmotic Diuretic – pulls fluid  Hyperglycemia causes fluid and electrolyte imbalances leading to the classic manifestations of DM Polyuria: excess urine loss results from osmotic diuresis – glucose spills into urine pulling more fluid, e-lyte’s are lost, severe water loss Polydipsia: excess thirst Polyphagia: excessive hunger Zena’s story  Role of the nurse: Health promotion Maintenance to identification, monitoring and education of Goals for client’s at risk of developing DM Diabetes Assessing acute situations Priorities of care*** What education should you be providing the patient and their significant others? How will you assess if the Nursing patient/family understand the Responsibiliti information you have provided them? es? What means will you use to health teach a patient and/or their significant others if they speak a different language, are of a different culture or they are unable to hear or speak? Diabetic ketoacidosis (DKA) DIABETES NURSING MANAGEMENT Etiology*** know causes Undiagnosed DM Usually patient comes in with DKA before having diagnosis of DM Usually from type 1 Inadequate treatment of existing DM Insulin not taken as prescribed, or omitted Infection Type 1 Dehydration owing to illness with vomiting or diarrhea Change in diet, insulin or exercise regimen – keep sugar high before exercising and make sure you have something sweet after exercise to prevent drop DKA How would you define it?  Life threatening  Occurs most often in people with type 1 DM  Usually triggered by a physical stressor  Body starts to break down fat at a fast rate  Liver turns the fats into fuel (Ketones) which makes the blood acidic  Manifestations Hallmarks:  D (DRY & HIGH SUGAR)  Dehydrated and high glucose  K (Ketones & Kussmaul resp. – rapid and fruity)  Fat turns into ketones  A (Abdominal Pain)  A (Acidosis Metabolic) Diabetic ketoacidosis Characterized by:  Hyperglycemia  Metabolic acidosis  Ketosis  Dehydration (volume depletion)  What is the clinical presentation of DKA? Dehydration: poor skin turgor, Polyuria, Polydipsia altered LOC, lethargy, Weight loss tachycardia, and hypotension Profuse vomiting are often present on Diffuse abdominal pain examination. Lab findings: Fruity smelling breath BS > 14 mmo/L Kussmaul breathing—a deep, pH < 7.35 labored pattern indicative of a Bicarb < 15 mmol/L hyperventilatory response to Ketones in blood and urine metabolic acidosis R. Van Ness-Otunnu and J. B. Hack 2013  Nursing Assessment What is included in your nursing assessment? Review of systems Subjective Data Objective Data Diagnostic Testing R. Van Ness-Otunnu and J. B. Hack 2013  Nursing Assessment Dry mouth Rapid, weak pulse, orthostatic hypotension Thirst Laboured breathing (Kussmaul’s Abdominal pain respirations) N&V Fever Gradually increasing restlessness, Urinary frequency confusion, lethargy – dehydration and acidosis Serum glucose >14mmol/L Flushed, dry skin Glucosuria, ketonuria – should not have** Eyes appear sunken Key significant from type 1 and type Breath odour of acetone 2 Nursing Diagnosis What are some potential nursing diagnosis, and goals for patients experiencing diabetes hyperglycemic crisis?  DKA – what is the goal of treatment What is your absolute priority for DKA? And Why? Explain how the empirical knowledge will guide your care? - *FLUID RESUSITICAN IS KEY* - Normal saline is commonly used - Bring BP and reprofuse organs ( kidneys) - After providing fluid, understand the issue/cause - Check electrolytes ( potassium) with insulin moves into the cell (hypokalemia) What is the goal for DKA? Goals of treatment include: Identifying the underlying cause Replace fluid volume, re-establish euglycemia Resolve ketonemia, correct acidosis Improve mental status Optimize renal perfusion, replete electrolytes & minerals Prevent complications MANAGEMENT OF DKA ** super important DKA & HHS DeBeer et al., 2008  Management IV fluid replacement: Correct water & electrolyte deficits over the next 24-48h to replete ECF & restore ICF volume Begin fluid resuscitation with 0.9Nacl solution until BP stabilized and urine output 30- 60ml/hr ** FIRST** Management of electrolytes: K+ IV to correct hypokalemia IV Na bicarb if severe acidosis (pH