Medical Surgical Nursing Diabetes Mellitus. Endocrine Pancreas Islets of Langerhans Beta cells...

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Transcript of Medical Surgical Nursing Diabetes Mellitus. Endocrine Pancreas Islets of Langerhans Beta cells...

  • Slide 1
  • Medical Surgical Nursing Diabetes Mellitus
  • Slide 2
  • Endocrine Pancreas Islets of Langerhans Beta cells Insulin
  • Slide 3
  • Insulin Produced and secreted by Beta cells
  • Slide 4
  • Insulin Primary function Stimulates the active transport of glucose from the blood into muscle, liver and adipose tissue __?__ blood glucose levels
  • Slide 5
  • Glucose Content of Food Consume food glucose blood stream *Carbohydrates Starch Simple Complex
  • Slide 6
  • Secretion of Insulin Is stimulated by: What change in homeostasis causes the beta cells to secrete insulin? Hyperglycemia Glucose levels in the bloodstream regulate the rate of insulin secretion
  • Slide 7
  • The major action of insulin blood glucose levels the permeability of target cell membrane to glucose Main target cells Muscle Liver Adipose tissue
  • Slide 8
  • Pathophysiology sumamry Increased blood glucose levels Gland Pancreas B cells Insulin Target cells (muscles) (insulin pulls glucose from the blood into the muscles) Decrease blood glucose levels
  • Slide 9
  • Insulin info In the absence of insulin, glucose is not able to get into the cells and it is excreted in the urine Glycouria Brain cells are not dependent on insulin for glucose intake
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  • Function of Insulin Need insulin for glucose to cross cell membrane No insulin no glucose into the cell Glucose stays in the blood Hyperglycemia
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  • Diagnostic tests Blood glucose / Fasting blood glucose Glycosylated Hemoglobin Assay
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  • Blood Glucose Fasting blood Glucose Measures blood glucose levels after fasting Results Normal 70-115 mg/dL Diabetic level > 126 mg/dL Critical > 400 mg/dL Critical < 50 mg/dL
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  • Fasting Blood Glucose Nursing Responsibility Fast 6-8 hours Water OK No insulin or anti-diabetic meds Exercise will effect results
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  • Glycosylated Hemoglobin Assays (Hgb A1C) % of glycosylated hemoglobin RBC lifecycle @ 120 days (4 months) Glucose slowly binds with Hgb glycosylated serum glucose level glycosylated Hgb levels
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  • Hgb A 1 C Provides an average blood glucose levels Past 2-3 months Can be taken any time
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  • Normal levels (non-diabetic) 4-6% Diabetic level (goal)
  • Type 1 vs. Type 2 Age of onset Usually < 30 Age of onset Usually > 40
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  • Type 1 vs. Type 2 Body wt at onset Normal to thin Insulin production None Insulin injections Always Body wt at onset 80% overweight Insulin production Not enough Insulin injections Sometimes
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  • Type 1 vs. Type 2 Management Insulin Diet Exercise Management Diet (wt. Loss) Exercise Possibly oral hypoglycemic meds Possibly insulin
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  • Other specific types of Diabetes Mellitus Gestational Pancreatitis Drug or chemical induces diabetes (steroids)
  • Slide 36
  • S&S of Diabetes Mellitus Definition: A group of disorders characterized by chronic Hyperglycemia 3 P s Polydipsia Polyuria Polyphagia
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  • S&S of Hyperglycemia Neurological C/O headache Dull senses Stupor Drowsy Blurred Vision
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  • S&S of Hyperglycemia Cardiovascular Tachycardia Decreased BP (Dehydration) Respiratory Kussmaul's respirations Sweet and fruity breath Acetone breath
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  • S&S of Hyperglycemia Gastro-intestinal Polyphagia N/V Polydipsia
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  • S&S of Hyperglycemia Genital-urinary Polyuria Glycosuria Skeletal-muscular Weak
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  • S&S of Hyperglycemia Integumentary Dry skin Flushed face
  • Slide 42
  • Small Group Questions Mr. McMillan is a 50 year old client brough into the ER with extreme fatigue and dehydration. After the MD sees him the nurses asks Mr. McMillan some additional questions. Based on the clients answers the nurse requests that the MD add a glucose level to the lab work. The results are 800mg/dL.
  • Slide 43
  • Small group questions 1.What question did the nurse most likely ask? 2.Why was Mr. McMillan fatigued? 3.Why was he dehydrated?
  • Slide 44
  • Medical Management of DM No cure Goal is Control! And prevent complications Individualized treatment plans Diet Exercise Meds
  • Slide 45
  • Dietary management of DM Foundation of Diabetic control Goals Maintain near-normal blood glucose levels Achieve optimal serum lipid levels Provide adequate calories for reasonable weight Prevent & treat acute complications of insulin- treated diabetes Improve overall health through optimal nutrition
  • Slide 46
  • The exchange system Six categories Starch Meat Milk Vegetable Fruit Fat
  • Slide 47
  • General guidelines of Dietary Management Protein 20% Fat 20% Carbohydrates 60% ADA: American Diabetic Association
  • Slide 48
  • Diabetic Meal Plan Small frequent meals CONSISTENCY! Amount of calories Amount of carbohydrates Time Snacks
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  • Diabetic Meal Plan If the client is obese, the key to treatment is Weight loss!
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  • Meal Plan considerations Food preferences Lifestyle Schedule Ethnic / Cultural background
  • Slide 51
  • Alcohol and Diabetes Increase risk of Hypoglycemia Moderation
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  • Exercise and Diabetes blood glucose levels
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  • More Benefits of exercise Increases circulation Improve serum lipid levels Improves cardiovascular status Assist with wt control Decreases stress
  • Slide 54
  • Rules for the exercising diabetic Talk to MD first Regular vs. sporadic Correlate exercise and glucose levels Don t exercise when hypoglycemic Don t exercise when hyperglycemic >250
  • Slide 55
  • Rules for the exercising diabetic Do not exercise when insulin is peaking Carry a quick source of sugar Best time = 60-90 minutes after a meal
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  • Rules for the exercising diabetic Proper footwear May need a pre- exercise snack Consistency!
  • Slide 57
  • Monitoring Glucose Glucometers FSBS 2-4 times a day
  • Slide 58
  • Small Group Questions 1.Give signs & symptoms of hyperglycemia by body system (Why do they manifest these symptoms?) 2.A diabetic meal plans main goal is to maintain near normal glucose levels. How is this done? 3.The exchange diabetic meal plan is divided into six categories, what are they?
  • Slide 59
  • Small Group Questions 4. What affect does alcohol have on a diabetic? 5. What affect does exercise have on a diabetic? 6. What council would you give a diabetic regarding exercise?
  • Slide 60
  • Onset Peak - Duration Onset The time period from injection to when it begins to take effect Peak When insulin is working its hardest and therefore blood glucose levels are at their lowest
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  • Onset Peak - Duration Duration Length of time the insulin works or lasts
  • Slide 62
  • Types of Insulin Very short acting/ rapid acting Lispro (Humalog) Aspart (Novolog) Insulin pumps Rapid reduction of glucose level AppearanceOnsetPeakDuration Clear hour1 hour3 hours
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  • Types of Insulin Short-acting / regular AppearanceOnsetPeakDuration Humalog R; Novolin R; Iletin II Regular
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  • Types of Insulin Short-acting / regular AppearanceOnsetPeakDuration Clear Humalog R; Novolin R; Iletin II Regular
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  • Types of Insulin Short-acting / regular AppearanceOnsetPeakDuration Clear - 1 hr (1 hour) Humalog R; Novolin R; Iletin II Regular
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  • Types of Insulin Short-acting / regular AppearanceOnsetPeakDuration Clear - 1 hr (1 hour) 2-3 hrs (3 hour) Humalog R; Novolin R; Iletin II Regular
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  • Types of Insulin Short-acting / regular AppearanceOnsetPeakDuration Clear - 1 hr (1 hour) 2-3 hrs (3 hour) 4-6 hrs (5 hours) Humalog R; Novolin R; Iletin II Regular Administered 20-30 minutes before meals IV Usually given 4 x a day
  • Slide 68
  • Types of Insulin Intermediate-acting AppearanceOnsetPeakDuration NPH; Humulin N; Lente: Novolin L; Novolin N
  • Slide 69
  • Types of Insulin Intermediate-acting AppearanceOnsetPeakDuration Cloudy NPH; Humulin N; Lente: Novolin L; Novolin N
  • Slide 70
  • Types of Insulin Intermediate-acting AppearanceOnsetPeakDuration Cloudy2-4 hrs (2 hrs) NPH; Humulin N; Lente: Novolin L; Novolin N
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  • Types of Insulin Intermediate-acting AppearanceOnsetPeakDuration Cloudy2-4 hrs (2 hrs) 6-12 hrs (12 hrs) NPH; Humulin N; Lente: Novolin L; Novolin N
  • Slide 72
  • Types of Insulin Intermediate-acting AppearanceOnsetPeakDuration Cloudy2-4