1. Endocrine 3A Part 3

2. Long Term Complications of Diabetes Macro vascular complications – Arteriosclerosis Characterized by thickening and loss of elasticity of the arterial walls “ hardening of the arteries ”. – Coronary Artery Disease – Cerebrovascular Disease – Peripheral vascular disease

3. Coronary/cerebrovascular disease Changeable risk factors Weight control Low-fat diet Treat hypertension Treat hyperlipidema Regular exercise Control blood glucose levels Smoking Diabetes Unchangeable risk factors Age Gender Family history Race

4. Microvascular complications Characterized by basement membrane thickening Effects smallest blood vessels Due to hyperglycemia

5. Diabetic Retinopathy Damage to the tiny blood vessels that supply the eye  Small hemorrhages occur Damage is due to hyperglycemia

6. Prevention Control – Glucose – BP

7. Prevention No straining Use laxatives Avoid lowering head Avoid lifting above shoulders

8. Retinopathy: Medical Management Photocoagulation “ laser ” treatment Control hypertension Control blood glucose No smoking

9. Retinopathy: Nursing Considerations Expected Odds are good Frequent eye exams Bilateral but uneven

10. Other Optic Complications Cataracts Lens Changes Extraocular muscle palsy Glaucoma

11. Nephropathy Damage to the tiny blood vessels within the kidney. Due to – Hyperglycemia

12. Nephropathy: Etiology  glucose levels – Stress kidney ’ s filtration mechanism Blood protein leaks into urine Pressure in blood vessel of kidney  Kidney failure

13. Nephropathy: Pathophysiology Normally Kidneys filter blood Small molecules & waste squeeze through kidneys  urine Big stuff (I.e. protein, RBC), stay in blood where they belong

14. Nephropathy: Pathophysiology Diabetes damages the system Filters start to leak Protein and RBC lost in urine – Microalbuminuria – Macroalbuminuria – Proteinuria

15. Nephropathy: Pathophysiology Filters collapse Lose of filtering ability – Kidney failure – ESRF / ENRD Waste products build up in blood Dialysis Kidney transplant

16. Nephropathy: S&S / Dx Proteinuria / albuminuria  urine output Edema BUN & Creatinine ↑  BP

17. Nephropathy:Prevention Control BG Control HTN Tx UTI No nephrotoxic substances  Na  Protein

18. Nephropathy:Management Tight glucose control Anti-hypertensives – Calcium-channel blockers – Alpha blockers – ACE inhibitor Dialysis Transplant

19. Neuropathy Damage to the Nerves due to hyperglycemia Most common complication Various Types of Neuropathies …

20. Neuropathy Sensory-Motor Polyneuropathy – AKA peripheral neuropathy – Paresthesias: primarily lower extremities –  deep tendon reflexes

21. Neuropathy  Sensory-motor  Numb feet   proprioception   sensation  Unsteady gait   risk foot injury

22. Neuropathy: Management Control serum glucose levels Pain control – Analgesics (non- narcotic) – Tri-cyclic antidepressants – Anticonvulsants

23. Neuropathy: Autonomic neuropathy – Autonomic NS – Can affect almost any system

24. Autonomic Neuropathy Cardiovascular – Tachycardia – Orthostatic hypotension – MI

25. Autonomic Neuropathy Gastro-intestinal – Delayed gastric emptying – Constipation – Diarrhea

26. Autonomic Neuropathy Urinary – Retention – Neurogenic bladder

27. Autonomic Neuropathy Reproductive – Male impotence

28. Autonomic Neuropathy Adrenal Gland – “ Hypoglycemic Unawareness ” – Adrenal Medulla – Adrenergic symptoms – No longer feel S&S – Strict BG control & frequent monitoring

29. Autonomic Neuropathy Sudomotor neuropathy – No sweating – Anhidrosis –  dry feet –  foot ulcers

30. Infections High risk of foot infections – Neuropathy Pain sensation –– Pressure sensation –– Dryness –– Fissures ––

31. Infections Peripheral vascular disease – Circulation  – WBC  – Oxygen  – wound healing Poor – Antibiotics  – Gangrene

32. Infections Immuno-compromised – WBC + hyperglycemia = sluggish WBC ’ s

33. Infections Once they occur  difficult to treat – Poor circulation – Antibiotic not get there – Sluggish WBC ’ s – Unknown wounds

34. Infections Particular concern – Foot infections/wounds

35. Boils:  AKA: "furuncles"  round, pus-filled bumps on the skin  D/T: Staphylococcus aureus bacteria

36. Cellulites noncontagious inflammation of the connective tissue of the skin, D/T bacterial infection Treatment – Antibiotics – Analgesics

37. Infections of concern UTI ’ s Yeast Infections Periodontal disease

38. Infections of concern Gangrene term to describe the decay or death of an organ or tissue d/t  blood supply.

39. Infections of concern (FYI) Necrotizing fasciitis – Flesh eating disease

40. High risk for foot infections Duration of diabetes  Age Smoking  Peripheral pulses  Sensation Deformities/pressure areas Hx of foot ulcers

41. Progression of events Soft tissue injury  Injury not sensed  Infection  Drainage, swelling, redness  Gangrene 

42. Management of infections Bed rest Antibiotics – Topic vs. IV Debridement Control Glucose levels ? Amputation

43. Nursing Management Teach foot care – prevention Teach wound care

44. Guideline to Healthy Feet Wash daily – Dry between toes – Lubricate dry feet Inspect – Mirror – Family – Between toes

45. Guideline to Healthy Feet Avoid activities that  circulation – Smoking – Crossing legs – Tight socks

46. Guideline to Healthy Feet Good shoes – Comfortable – Closed toe – No bare feet – New shoes Break in slowly

47. Guideline to Healthy Feet Prevent injuries – Wear socks Cotton Light color No wrinkles – Check inside of shoe

48. Guideline to Healthy Feet No temperature extremes – Check bath water – No water bottles – No heating pads

49. Guideline to Healthy Feet See doctor regularly – Podiatrist – Trim straight across – Do not cut calluses or corns

50. Guideline to Healthy Feet Range of Motion

51. Diabetics & Surgery BS levels _____ during stress, surgery & illness – –  If not controlled (BG)  osmotic diuresis  dehydration

52. Diabetics & Surgery Risk of _________ if give shot of NPH and then NO surgery or surgery delayed – Hypoglycemia

53. Diabetics & Surgery Management – Check BS before surgery – No sub-Q – IV

54. Hospitalized diabetic Independence Sliding scale Diets – NPO Still need insulin – Clear liquids Most simple carbs Low sugar if possible

55. NCLEX Question Peripheral vascular disease is most common in patients with A.an aneurysm. B.viral pneumonia. C.leukemia. D.diabetes mellitus.

56. NCLEX Question The nurse is reinforcing the importance of proper foot care to the elderly diabetic. The woman states that they surely must have something more important to discuss. The nurse correctly replies: A.“Foot care as well as any other type of hygiene is always important.” B.“We can skip this if you prefer.” C.“All right, just remember that you will be more prone to foot odor.” D.“Diabetics can easily develop severe foot injury or infection without knowing it.”