DM II

DM II

1. Nursing Process

   • Evaluation
     • health benefits
     • patient knowledge - self monitor blood glucose (SMBG), diet changes, lifestyle changes, personal hygiene
   • implemntation
     • Resources
       • consult dietician, physiotherapist, personal trainer, family support, psychologist
     • Treatment
       • Pharmacology
         • insulin therapy
           • rapid-acting (Humalog, NovoRapid), regular/fast-acting (Humalin-R, Hypurin-R), Intermediate-acting (Humulin-M, Humulin-L, Hypurin-N), Long-acting (Humulin-U) Extended long-acting analog Lantus)
         • sulfonylureas, meglintinides, biguanides, thiazolidinediones, alpha glucosidase inhibitors, incretin stimulators, dipeptidyl peptidase 4 inhibitors, pramlintides, sibutramine
       • Diet
         • Low fat, low sugar intake, low glycemic index food
           • insert images of food 
       • Lifestyle
         • individualized exercise program - cardio + resistance exercise
       • natural therapy
         • Stevia (Stevia rebaudiana), Ginseng, Aloe Vera, Cinnamon
   • Planning
     • 1. active patient participation 2. few or no episodes of acute hyperglycaemia emergencies or hypoglycaemia 3. maintain normal blood glucose levels 4. prevent or delay chronic complications 5. lifestyle adjustments with minimal stress
   • Assessment
     • Subjective
       • Symptoms
         • 3 P's: Polyuria, Polyphagia, Polydipsia
         • Fatigue, muscle weakness, skin infection, pruritus, abdominal pain, headaches, depression, malais, weight gain, consitpiation or diahrrea, decreased libido, frequent vaginal infection, erectile dysfunction
       • Health History: mumps rubella or other viral infections, recent trauma, infection, stress level, pregnancy, chronic pancreatis, Cushings syndrome, last eye exam medication,' recent surgery, family history
     • Objective
       • body profile - Waist circumference, BMI
       • Eyes - virtual haemorrhage, cataract, soft sucker eyeballs
       • Integumentary - dry, warm, inelastic skin, pigmented, lesions on legs, loss of hair on toes
       • Respiratory - rapid, deep respiration (Kussmual's Respiration)
       • Cardiovascular- hypotension, weak rapid pulse, peripheral pulse diminished, feet pale and cool to touch
     • Diagnostic Studies
       • 1. AIC ≥ 6.5%, 2. fasting plasma glucose level ≥ 7mmol/L, 3. random or casual plasma glucose measurement ≥11 mmol/L plus classic symptoms, 4. two hour OGTT level ≥11.1 mmol/L when a glucose load of 75g is used

2. Complications

   • extreme hyperglycemia
     • severe osmotic diuresis
       • fluid volume deficit
         • ↓ Na+, ↓ K+, ↓ P3-
           • eletrolyte imbalance
             • profound dehydration
               • hyperosmolality
                 • hypovolemia
                   • ↓ renal perfusion
                     • oliguria
                       • anuria
                     • ↓ SV
                       • ↓ CO
                         • CHF
                         • Left ventricular hypertrophy
                           • edema, fatigue
                     • ↑ RAA activity
                       • Renal hypertension
                   • hypotension
                     • tissue anoxia
                       • ↑ lactic acid
                         • seizure, shock, coma
                           • Death
                       • ischemia
                         • necrosis
                           • wet/dry gangrene
                             • Infection
                         • peripheral nerve damage
                           • loss of sensation/pain
                   • hemoconcetration
                     • hyperviscosity
                       • thrombosis
                         • embolism
                           • cardiac
                             • myocardia ischemia
                               • myocardial infarction
                           • pulmonary
                             • pleural effusion
                               • right sided heart failure
                                 • Cor pulmonale
                           • pheripheral
                           • neural embolism
                             • stroke
                       • hyptension
                         • arteriosclerosis
                         • retinopathy
                           • blindness
     • ↑ sortibtol and fructose in nerves
       • ↓ nerve conduction and demylinization
         • sensory neuropathy
           • paresthesias, abnormal sensations, pain, loss of sensation
         • autonomic neuropathy
           • delayed gastric emptying
             • anorexia, nausea, vomiting, gastroesophageal reflux
           • decreased libido (F), erectile dysfunction (M)
           • neurogenic bladder
             • infrequent voiding, difficulty voiding, weak stream of urine
     • ketoacidosis
       • acute cerebral edema
     • yeast infection

3. Risk factors

   • modifiable
     • lifestyle, diet, environment, viral infection
   • non-modifiable
     • race, age, gender, genetic, environment