CH 51 Caring for Clients With Diabetes Mellitus

Which groups of people have the highest incidence of diabetes mellitus?

- Native Americans - Alaskan Natives - Non-Hispanic Blacks

Nursing management of DKA

- monitor IV infusions closely and take vitals frequently - monitor for fluid overload - check serum electrolyte findings - blood glucose level measured frequently

Causes of hypoglycemia

- not eating and continuing to take insulin or oral antidiabetic medications - exercising more that usual, which lowers available blood glucose

Once the hypoglycemic symptoms are relieved, the client with diabetes is given _______________________ such as graham crackers and milk to sustain and prolong an adequate level of blood glucose

complex carbohydrates

When type 2 diabetes is manifested, the beta ells of the islets of Langerhans secrete ___________________ levels of insulin to offset hyperglycemia but blood glucose level remains higher than normal.

increased

Diabetes in adults is one consequence of __________________________, which includes obesity, especially in the abdominal area; high blood pressure; elevated triglyceride, low-density lipoprotein, blood glucose levels; and a low high-density lipoprotein level

metabolic syndrome

Signs and symptoms for both types of diabetes

polyuria, polydipsia, pholyphagia weight loss thirst fatigue dehydration skin, urinary tract, and vaginal infections changes in vision

Neuropathy results from ________________ and decreased blood circulation to the nerve tissue

poor glucose control

Can lead to type 2 diabetes, heart disease, and stroke

prediabetes

Which type of diabetic retinopathy is the most severe and can lead to blindness?

proliferative retinopathy

The age of the highest among newly diagnosed age groups for type 2

45 to 64

The blood pH range in DKA?

6.8-7.3

Diagnostic findings of diabetic nephropathy

A routine urinalysis or dip with a chemical strip detects albumin in the uine. The blood urea nitrogen and serum creatinine become elevated. Renal creatinine clearance is decreased.

Diagnostic findings of peripheral neuropathy

Neuro exam validates when a tuning fork is in contact with the skin of the extremities. And electromyography studies.

In clients with diabetes all the arteries and arterioles are more susceptible to accelerated ____________ and _____________ changes than those without diabetes

atherosclerotic and arteriosclerotic

When the blood glucose falls below what number has hypoglycemia occurred?

below 70 mg/dL

The ________________________ attempts to neutralize the ketones.

bicarbonate buffer system

Assessment findings of diabetic retinopathy

bluured vision, no vision in spotty areas, or seeing debris floating. Visual acuity diminished, swelling near macula which provides central vision.

How does exercise help manage diabetes?

controls blood glucose levels and improves circulation of blood

When ketones accumulate in the blood, clients with diabetes are prone to developing a form of metabolic acidosis known as ___________________.

ketoacidosis

Breakdown of subcutaneous fat at the site of repeated injections

lipoatrophy

Buildup of subcutaneous fat at the site of repeated injections

lipohypertrophy

Results in the accumulation of fatty acids and ketones, metabolic by-products of fat metabolism.

lipolysis

The breakdown of fat

lipolysis

Type 1 is usually diagnosed at what age?

people younger than 20

Which insulin can be administered IV and subcut?

rapid-acting and short-acting

Which type of diabetic would not be offered a pancreas transplant?

Type 2 because the problem is with insulin resistance.

Inherited disease, obesity is a cofactor that triggers its onset

Type 2 diabetes

Insulin resistance, a decreased sensitivity to insulin at the tissue level

Type 2 diabetes

Treatment for HHNKS

-administration of insulin and correction of fluid and electrolyte imbalances -central catheter may be used to monitor the client's hemodynamic response to fluid replacement

Medical management of diabetes

-diet and weight loss -exercise -insulin -oral antidiabetic agents -pancreas transplantation -islet cell transplantation

Signs and symptoms of peripheral neuropathy

-pain -skeletal muscles become smaller -feet swell and become insensitive to temp or tactile stimuli -disturbing

Main goals for treatment of DKA?

-reduce the elevated blood glucose -correct fluid and electrolyte imbalances -clear the urine and blood of ketones

U100 means that ______________________

1 mL contains 100 units of insulin

The fasting blood glucose of a prediabetic

100 to 125

the oral glucose tolerance test level of a prediabetic

140 to 199

Glycosuria appears when the blood glucose level rises above __________ renal threshold is impaired

180 mg/dL

What indicates peripheral vascular disease?

Angiography and Doppler ultrasonic flow studies.

Medical and Surgical management

Atherosclerosis is managed with lipid-lowering measures such as a low-fat diet, exercise, and medications. Vasodilators to combat arteriosclerosis. Drugs that reduce platelet aggregation.

Affect organ functioning (ex: Gastroparesis)

Autonomic neuropathy

Medical management of diabetic nephropathy

Controlling both blood glucose levels and hypertension can prevent or delay the development of diabetic nephropathy. Moderate reduction in protein, smoking cessation strongly recommended.

Metabolic disorder of the pancreas, affects carbohydrate, fat, and protein metabolism.

Diabetes mellitus

In which condition does the breathing being rapidly and deeply in an attempt to eliminate CO2 and prevent it from forming carbonic acid, which would contribute even more to the acidotic state? If the condition is severe and prolonged, a comatose state follows.

Diabetic Ketoacidosis

Those who develop ____________ often have a severe, hard-to-control form of the disease (brittle or unstable diabetes). Other causes of this serious event are infections and nonadherence to the treatment regimen.

Diabetic Ketoacidosis

A consequence of glomerular deterioration with five stages

Diabetic Nephropathy

Referes to the progressive decrease in renal function that occurs with diabetes mellitus.

Diabetic Nephropathy

What occurs with HHNKS with a subsequent loss of sodium and potassium?

Diuresis

Assessment findings of diabetic ketoacidosis

Early symptoms are vague and become more definite and serious as increasing ketones accumulate in the bloodstream. -weakness, thirst, anorexia, vomiting, drowsiness, and abdominal pain -cheeks are flushed, skin and mouth are dry -breath has an odor of acetone -Kussmaul's respirations -pulse is rapid and weak -BP is low

What type of breathing are common in ketoacidosis?

Kussmaul's respirations (fat, deep, labored)

Diagnostic tests for diabetic retinopathy

Fluorescein angiography

Often results from a serious illness during which metabolic needs exceed the limits of available insulin

HHNKS

Elevated blood glucose level, is associated with other disorders of their management.

Hyperglycemia

In this condition the blood glucose level is well over 500 mg/dL, but the pH remains within normal range of 7.35 to 7.45

Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNKS)

Assessment findings of HHNKS?

Hypotension, mental changes, extreme thirst, dehydration, tachycardia, and fever develop. Neurologic signs include paralysis, lethargy, coma, and seizures. Physical exam reveals dry mucous membranes and poor skin turgor.

What do we do if the insulin begins to lower the blood glucose level?

IV solution is changed to include one with glucose, which avoids the potential for hypoglycemia.

How do we accomplish the goals of treatment of DKA?

Insulin given intravenously. Regular insulin is added to an IV solution and infused continuously

Nursing management for HHNKS

Monitor blood glucose level and assess for electrolyte imbalances and dehydration. Priority areas for evaluation include hydration status, I&O, turgor, V/S, electrolyte studies, neurologic and cognitive symptoms

Incidence is highest among which age?

Over 65

Are given despite elevated serum levels to raise intracellular stores in treatment of DKA

Potassium replacements

Nursing management of peripheral neuopathy

Rise slowly from a lying or sitting position, to drink generous fluids, and to wear knee-high or thigh-high elastic stockings during waking hours

Considered an autoimmune disorder

Type 1 diabetes

When does ketoacidosis develop in type 1 diabetes?

Suddenly, due to total cessation of insulin production.

The islets cells, or endocrine portion of the pancreas, cease to produce insulin

Type 1 diabetes mellitus

Ketonemia causes a decreased alkali reserve, leading to _____________________

acidosis

Medical management of hypoglycemia?

administration of 15 to 20 g of simple carbohydrate ASAP. If unconscious glucose gel can be applied to the buccal cavity. Glucagon may of 50% glucose is prescribed for IV administration

______________________ also interferes with the liver's ability to synthesize glucose from noncarbohyrates, placing clients with diabetes at a higher risk for hypoglycemia.

alcohol consumption

Medical management of peripheral neuropathy

diet, exercise, and medication to control blood glucose levels with non-narcotic pain.

Both lipoatrophy and liphypertrophy do what?

eventually interferes with insulin absorption in the tissue

Assessment findings of vascular disturbances

extremities are pale and cool. Leg cramps occur. Gangrene can develop.

An excessive level of glucose in the blood leads to

glycosuria, glucose in the urine, and urinary excretion

When too much insulin is in the bloodstream relative to the amount of available glucose what occurs?

hypoglycemia

When these nerves are affected, the muscles weaken and atrophy, joint support is diminished.

motor neuropathy

Signs and symptoms of hypoglycemia

nausea, drowsiness, nervousness, hunger, tremors, malaise, excessive perspiration. Some have personality or behavioral changes, confusion and dizziness can occur.

The two types of diabetic retinopathy

nonproliferative retinopathy proliferative retinopathy

Medical management of diabetic retinopathy

ophthalmic evaluation within 3 to 5 years after diagnosis. If evidence of retinal vessel changes an ACE inhibitor prescribed to dilate and improve blood flow. Can also seal leaking or newly forming blood vessels with laser photocoagulatoin. Vitrectomy, removal of bloodied vitreous also improves vision clarity.

What blood glucose level would we see that would indicate DKA?

over 400

The ability to reabsorb glucose and return it to the bloodstream

renal threshold

Leads to paresthesias, abnormal sensations such as prickling, tingling, burning, or needlelike pain in the feet, legs, and sometimes hands.

sensory neuropathy

In HHNKS blood glucose levels are exceedingly high, _______________ levels are low.

serum potassium and sodium

Assessment findings of diabetic nephropathy

swelling in the feet and hands, BP increases gradually, feeling of tired and weakness.