Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Care of Patients with Diabetes Mellitus

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Type 1 Type 2 Gestational (GDM) Other specific conditions resulting in hyperglycemia

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Hyperglycemia Polyuria Polydipsia Polyphagia Ketone bodies Hemoconcentration, hypovolemia, hyperviscosity, hypoperfusion, and hypoxia Acidosis, Kussmaul respiration Hypokalemia, hyperkalemia, or normal serum potassium levels

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. A CUTE C OMPLICATIONS OF D IABETES Diabetic ketoacidosis Hyperglycemic-hyperosmolar state (HHS) Hypoglycemia from too much insulin or too little glucose

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. C HRONIC C OMPLICATIONS OF D IABETES Macrovascular/microvascular disease Retinopathy (vision problems) Nephropathy (kidney dysfunction) Neuropathy (nerve dysfunction)

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. M ACROVASCULAR C OMPLICATIONS Cardiovascular disease Cerebrovascular disease

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. M ICROVASCULAR C OMPLICATIONS Eye and vision complications Diabetic neuropathy Diabetic nephropathy Male erectile dysfunction

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. M ETABOLIC S YNDROME Also called syndrome X Classified as simultaneous presence of metabolic factors known to increase risk for developing type 2 diabetes and cardiovascular disease

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. H EALTH P ROMOTION AND M AINTENANCE Control of diabetes and its complications is major focus for health promotion activities

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. A SSESSMENT History Blood tests Fasting plasma glucose (FPG) Oral glucose tolerance test (OGTT) Other blood tests Screening Ongoing assessment—glycosylated hemoglobin assays, glycosylated serum proteins and albumin, urine tests, tests for kidney function

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. T ESTING S ENSATION

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. T REATMENT O PTIONS Oral therapies Insulin therapies Nutritional considerations Exercise Surgical intervention Foot care Wound care

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. P ATIENT E DUCATION Insulin storage Dose preparation Syringes Blood glucose monitoring Infection control measures Diet therapy

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. A CTIVITY : P ATIENT WITH A D IABETIC C ONDITION 1. Etiologies, risk factors, comorbidities 2. Assessment findings 3. Diagnostic tests 4. Nurse’s role 5. Interdisciplinary team’s role 6. Treatment/intervention priorities 7. Teaching/health promotion information 8. Community resources

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. A 23-year-old patient with a history of type 1 diabetes is admitted to the ED with nausea and abdominal pain. His respiratory rate is 34/min with deep breaths and a fruity smell to his breath. He is responsive, but difficult to arouse. 1. What does the nurse suspect is happening with this patient? 2. What serum glucose level would the nurse expect to see with this patient?

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. The student nurse asks why the patient is breathing so rapidly and deeply. What is the nurse’s best response? A. “His serum pH is high and this is a compensatory mechanism.” B. “His serum pH is low and this is a compensatory mechanism.” C. “His serum potassium is high and this is a compensatory mechanism.” D. “His serum potassium is low and this is a compensatory mechanism.” (cont’d)

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. In the ED, the patient is diagnosed with diabetic ketoacidosis (DKA). What is the nurse’s first priority for managing this condition? A. Airway assessment B. Fluid and electrolyte correction C. Administration of insulin D. Administration of IV potassium (cont’d)

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Twenty minutes later, the patient is admitted to the ICU for DKA management. The patient is receiving IV regular insulin with frequent finger sticks to check his glucose level. His potassium level is 2.5 and IV potassium supplements have been ordered. What assessment must be made before giving the IV potassium? A. Production of at least 30 mL/hr of urine B. Level of consciousness and orientation C. Finger stick glucose of less than 200 mg/dL D. Respiratory rate of less than 24/min (cont’d)

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Two days later the patient is recovered and is preparing for discharge. His wife asks about what they can do to prevent this from happening again. What should the nurse teach the patient and his wife? (Select all that apply.) A. Check blood glucose levels every 4 to 6 hours if anorexia, nausea, or vomiting is experienced. B. Check urine ketones when blood glucose is greater than 300 mg/dL. C. Decrease fluid intake when nausea and vomiting occur. D. Watch for and report any illness lasting more than 1 to 2 days. E. Monitor glucose whenever the patient is ill. (cont’d)

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. C HAPTER 67 Audience Response System Questions 21

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Q UESTION 1 What percent of the United States population has diabetes? A. 3.2% B. 5.6% C. 8.3% D. 10.1%

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Q UESTION 2 Which symptom requires immediate intervention during a hypoglycemic episode? A. Confusion B. Hunger C. Headache D. Tachycardia

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Q UESTION 3 When should a patient with type 1 diabetes avoid exercise? A. When serum glucose is less than 150 B. During colder months C. When ketones are present in the urine D. When emotional stressors are high for the patient