Question

Complications of Diabetes Mellitus: Priority Interventions for Diabetic Ketoacidosis (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 83)

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System Disorder ACTIVE LEARNING TEMPLATE: STUDENT NAME DISORDER/DISEASE PROCESS REVIEW MODULE CHAPTER Health Promotion and Disease Prevention Alterations in Health (Diagnosis) Pathophysiol ogy Related to Client Problem ASSESSMENT SAFETY CONSIDERATIONS Expected Findings Risk Factors Diagnostic Procedures Laboratory Tests PATIENT-CENTE RED CARE Complications Medications Client Education Nursing Care Therapeutic Procedures Interprofessional Care

Answer 1

Alteration in Health

Diabetes mellitus is a metabolic disorder characterized by inadequate production of insulin from pancreas.The cardinal features of DM are :

• polyuria,
• polydipsia
• polyphagia

It can be diagnosed by fasting blood sugar of 126mg/dl or higher and post prandial blood sugar more than 200mg/dl on two separate test indicates DM.

Pathophysiology related to client problem

Decreased production of insulin from islets of Langerhans cells of pancreas which causes reduced uptake of glucose and glucose amount in the blood elevates induces condition called Diabetes mellitus.

Health promotion and disease prevention

It is lifestyle disease can be prevented from ocuring.Various factors contributes to the condition which includes modifiable and non modifiable.The modifiable factors includes smoking,high fat diet,sedentary lifestyle,obesity etc.By eliminating these factors,various types of metabolic anomalies can be prevented.Prevention is always better than cure.

Risk factors

There are two kind of risk factors for DM : Modifiable and non modifiable

modifiable risk factors

• overweight or obesity
• High level LDL Cholesterol and low level HDL cholesterol
• sedentary lifestyle
• depression
• Smoking

Non modifiable risk factors

• Age
• Familial history

Expected findings

• Increased blood glucose levels
• symptoms poly uria,polyphagia and polydipsia
• fatigue
• Blurred vision
• weight loss
• not healing sores

Laboratory findings

• FBS level more than 126mg/dl and PPBS level more than 200mg/dl for two separate occcasions indicates diabetes

Diagnostic procedures

• FBS
• PPBS
• Glycated hemoglobin :Average blood sugar level for past 2-3 months.Hb A1C level more than 6.5%or higher on two different test
• Oral glucose tolerance test :mainly used in gestational induced diabetes

Medications

• Insulin injections
• oral hypoglycemic agents like metformin
• Insulin pump therapy

Therapeutic procedures

• Diet control: low fat and low carbohydrate rich diet
• foot care : Diabetic foot is a complication.So foot care is important.

Complications

• Diabetic keto acidosis:It is the formation of ketone bodies in the body due to very low insulin and high glucose levels.It may poison the body.Breathing difficulty may happen along with this.
• Diabetic foot: It is a common complication in patients with diabetes.In diabetic patients,even a small crack is difficult to heal.These wounds may develop and deteriorate and foot related complications may arise.Even in later stages,amputation may be done.
• Eye related complications:People with diabetes have more risk to develop glaucoma and cataracts than non diabetics.Diabetic retinopathy is the major condition.
• Peripheral neuropathy:Nerve damage associated diabetes.Tingling sensation and lack of sensation are the main features.Lack of sensation may cause injuries to the foot which may not be noticed by the patients complicates into diabetic foot.
• Kidney diseases and stroke are other complications

Nursing care

• Instruct patient to check glucose level frequently
• Check whether patient adhere to the treatment plan.
• Check effectiveness of treatment
• Check for complications like DKA,foot complications
• Provide aseptic foot care

Client education

• Instruct patient to follow low carbohydrate and low fat rich diet
• Teach patients all the signs and symptoms of complications and low sugar level.
• Instruct them not to skip meals and always carry sweets to have during signs of low glucose levels
• Check for upper and lower extremities for any kind of abrasions and wounds.Instruct to follow good personal hygiene and do foot care
• Do exercise and not be lazy

Safety considerations

• Hypoglycemia is one of the important safety issue in diabetic patients.Sometimes due to missing of food or over strain due to employment may cause to reduce blood glucose level.The patient may feel blurring of vision and fainting.
• Be aware of the complications such as DKA and its signs and symptoms.