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<Discussions Get Email Updates Homework 3- Care of the Diabetic Patient by Lee Gilbert. 2 months ago Discussion Info Max Comments Unlimited Dashboard Max Replies Unlimited Info Please see rubric guidelines of the syllabus. Must be written in WORD Document Double Space Must upload in Populi Assignments Lessons Report Discussions Sort by Oldest

Please make sure to write and introduction body and conclusions. Write in word document and please dont forget every references used thanks ??

Answer 1

#. Pathophysiology of diabetes, and classification systems

-diabetes is the lack of uptake of the Beta cells of insulin, or the inability to secrete

Type 1-beta cell destruction, autoimmune with absolute insulin deficiency, thin

Type 2-insulin resistance-other specific conditions resulting in hyperglycemia-drug induced, infectious, genetic defects, overweight

Gestational diabetes-glucose intolerance with onset or first recognition during pregnanc

#. Nursing Interventions for safe and effective care in patients and their families with diabetes mellitus

-Health care team approach

-nutritional interventions

-blood glucose monitoring

-planned exercise

-oral agents or insulin to lower blood glucose, Type 1 DM can only be controlled with insulin

#. Health promotion activities to decrease the incidence of diabetes, assessment factors, and laboratory assessments for diagnosis

health promotion-focus on controlling hyperglycemia, low calorie diet and exercise can improve cardiac and metabolic factors, tight control of blood glucose levels can prevent complications, improving weight loss, exercise and increasing HDL's can reduce the incidence of type 2 by 58% in older adults

assess-HbA1c >6.5% is diagnostic, FBG-126mg/dl on 2 samples after 8 hr. fasting diagnostic, random blood glucose>200 mg/dl, OGTT-most sensitive, pregnant women, 2 or more levels are elevated, urine ketones-indicate severe lack of insulin

#. Priority nursing problems for patients with diabetes

potential for injury R/T hyperglycemia, potential for impaired wound healing R/T endocrine and vascular effects of diabetes, potential for injury R/T diabetic neuropathy, pain r/t diabetic neuropathy, potential for injury r/t diabetic retinopathy, potential for impaired renal circulation, potential for hypoglycemia, potential for DKA-inc. sugars cause you to pass out, potential for hyperglycemic-Hyperosmolar state and coma

#. Type of insulin and insulin regimes to manage blood sugar, with identification of nursing safety priorities

rapid acting-aspart, lispro (Novolog, Humalog) onset 5-15 minutes, peaks in 1-3 hrs, lasts 3-5 hrs

short-acting-regular insulin, (Humulin R) onset in 30 minutes, peaks 2-4 hrs, lasts 5-7 hrs

Intermediate acting-NPH insulin, (Novolin N) onset in 1.5 hrs, peaks in 4-12 hrs, lasts 16-24 hrs

long-acting-insulin glargine or lantus, onset is 2-4 hrs, no peak, lasts 24 hrs-basal

-Biguanides-Metformin(glucophage), controls a leaky liver, usually first drug used

#. Patient-centered education for blood glucose monitoring

Self monitoring of glucose monitoring-SMBG assists in reaching target blood glucose levels and in prevention of hypoglycemia

-Home meters measure whole blood, which is 10-15% lower than lab samples

-Multiple times a day is often required for multiple insulin injections-3-4x a day

-talking meters for the visually impaired

#. Nutritional management for diabetes with carbohydrate counting and use of exchange lists :-

total carbohydrates 45-65% and include fruits, vegetables, whole grains, legumes and low fat milk, min. of 130g per day

-protein intake 15-20%, less with kidney disease

-fiber to 14g per 1000 calories-monitor for hypoglycemia, AHA recommends 26 g/day

-limit saturated fat to less than 7%

-monitor alcohol use-2 fat exchanges, only with meals

-one food group equally exchanges for another in the same group. 1 slice of bread=1/2 cup of pasta

carb. counting-1 unit of rapid acting insulin covers 15g of carbohydrates-useful for insulin pumps

-2 slices of toast=32g carbs

-1/2 OJ is 1 exchange

#. Older adults are at increased risk for hypoglycemia, malnutrition, and dehydration-b/c they don't eat

-change in appetites, taste, smells, alot of salt

-poorly fitting dentures

-neuropathy and gastric retention

-reduced income, being alone decreases desire to prepare healthy meals

-regular visits by home health nurse can help

#. Nursing implications for blood glucose management for hospitalized patients

-Hyperglycemia increases with stress or infection, use of corticosteroids, tube feedings, parenteral nutrition

-hyperglycemia are directly related to higher wound infection rates

-prevention of hypoglycemia with altered nutrition

-during surgery and in ICU levels may be kept btw 140-180.

#. The priorities of assessment, interventions, and patient teaching to identify and treat peripheral neuropathy, and foot care are :-

-cleanse and inspect feet daily for redness, check bathwater temperatures, optimal 95 degrees F, wear proper shoes, no open toe, well-fitting, avoid walking bare-foot, get a doctor to trim toe-nails properly, cream on feet but not btw toes, report any nonhealing breaks in the skin to the health care provider