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Endocrine 3A

Endocrine 3A. Part 3. Long Term Complications of Diabetes. Macro vascular complications Arteriosclerosis Characterized by thickening and loss of elasticity of the arterial walls “ hardening of the arteries ” . Coronary Artery Disease Cerebrovascular Disease Peripheral vascular disease.

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Endocrine 3A

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  1. Endocrine 3A Part 3

  2. Long Term Complications of Diabetes • Macro vascular complications • Arteriosclerosis • Characterized by thickening and loss of elasticity of the arterial walls “hardening of the arteries”. • Coronary Artery Disease • Cerebrovascular Disease • Peripheral vascular disease

  3. Coronary/cerebrovascular disease Changeable risk factors • Weight control • Low-fat diet • Treat hypertension • Treat hyperlipidema • Regular exercise • Control blood glucose levels • Smoking • Diabetes Unchangeable risk factors • Age • Gender • Family history • Race

  4. Microvascular complications • Characterized by basement membrane thickening • Effects smallest blood vessels • Due to hyperglycemia

  5. Diabetic Retinopathy • Damage to the tiny blood vessels that supply the eye  • Small hemorrhages occur • Damage is due to hyperglycemia

  6. Prevention • Control • Glucose • BP

  7. Prevention • No straining • Use laxatives • Avoid lowering head • Avoid lifting above shoulders

  8. Retinopathy: Medical Management • Photocoagulation “laser” treatment • Control hypertension • Control blood glucose • No smoking

  9. Retinopathy: Nursing Considerations • Expected • Odds are good • Frequent eye exams • Bilateral but uneven

  10. Other Optic Complications • Cataracts • Lens Changes • Extraocular muscle palsy • Glaucoma

  11. Nephropathy • Damage to the tiny blood vessels within the kidney. • Due to • Hyperglycemia

  12. Nephropathy: Etiology • h glucose levels • Stress kidney’s filtration mechanism • Blood protein leaks into urine • Pressure in blood vessel of kidney h • Kidney failure

  13. Nephropathy: Pathophysiology Normally • Kidneys filter blood • Small molecules & waste squeeze through kidneys  urine • Big stuff (I.e. protein, RBC), stay in blood where they belong

  14. Nephropathy: Pathophysiology • Diabetes damages the system • Filters start to leak • Protein and RBC lost in urine • Microalbuminuria • Macroalbuminuria • Proteinuria

  15. Nephropathy: Pathophysiology • Filters collapse • Lose of filtering ability • Kidney failure • ESRF / ENRD • Waste products build up in blood • Dialysis • Kidney transplant

  16. Nephropathy: S&S / Dx • Proteinuria / albuminuria • i urine output • Edema • BUN & Creatinine ↑ • h BP

  17. Nephropathy:Prevention • Control BG • Control HTN • Tx UTI • No nephrotoxic substances • i Na • i Protein

  18. Nephropathy:Management • Tight glucose control • Anti-hypertensives • Calcium-channel blockers • Alpha blockers • ACE inhibitor • Dialysis • Transplant

  19. Neuropathy • Damage to the Nerves due to hyperglycemia • Most common complication • Various Types of Neuropathies…

  20. Neuropathy • Sensory-Motor Polyneuropathy • AKA peripheral neuropathy • Paresthesias: primarily lower extremities • i deep tendon reflexes

  21. Neuropathy • Sensory-motor • Numb feet • i proprioception • i sensation • Unsteady gait • h risk foot injury

  22. Neuropathy: Management • Control serum glucose levels • Pain control • Analgesics (non-narcotic) • Tri-cyclic antidepressants • Anticonvulsants

  23. Neuropathy: • Autonomic neuropathy • Autonomic NS • Can affect almost any system

  24. Autonomic Neuropathy • Cardiovascular • Tachycardia • Orthostatic hypotension • MI

  25. Autonomic Neuropathy • Gastro-intestinal • Delayed gastric emptying • Constipation • Diarrhea

  26. Autonomic Neuropathy • Urinary • Retention • Neurogenic bladder

  27. Autonomic Neuropathy • Reproductive • Male impotence

  28. Autonomic Neuropathy • Adrenal Gland • “Hypoglycemic Unawareness” • Adrenal Medulla • Adrenergic symptoms • No longer feel S&S • Strict BG control & frequent monitoring

  29. Autonomic Neuropathy • Sudomotor neuropathy • No sweating • Anhidrosis •  dry feet •  foot ulcers

  30. Infections • High risk of foot infections • Neuropathy • Pain sensation • i • Pressure sensation • i • Dryness • h • Fissures • h

  31. Infections • Peripheral vascular disease • Circulation • i • WBC • i • Oxygen • i • wound healing • Poor • Antibiotics • i • Gangrene

  32. Infections • Immuno-compromised • WBC + hyperglycemia = sluggish WBC’s

  33. Infections • Once they occur  difficult to treat • Poor circulation • Antibiotic not get there • Sluggish WBC’s • Unknown wounds

  34. Infections • Particular concern • Foot infections/wounds

  35. Boils: • AKA: "furuncles" • round, pus-filled bumps on the skin • D/T: Staphylococcus aureus bacteria

  36. Cellulites • noncontagious inflammation of the connective tissue of the skin, • D/T bacterial infection • Treatment • Antibiotics • Analgesics

  37. Infections of concern • UTI’s • Yeast Infections • Periodontal disease

  38. Infections of concern Gangrene • term to describe the decay or death of an organ or tissue • d/t i blood supply.

  39. Infections of concern (FYI) • Necrotizing fasciitis • Flesh eating disease

  40. High risk for foot infections • Duration of diabetes • h Age • Smoking • i Peripheral pulses • i Sensation • Deformities/pressure areas • Hx of foot ulcers

  41. Progression of events • Soft tissue injury  • Injury not sensed  • Infection  • Drainage, swelling, redness  • Gangrene 

  42. Management of infections • Bed rest • Antibiotics • Topic vs. IV • Debridement • Control Glucose levels • ? Amputation

  43. Nursing Management • Teach foot care • prevention • Teach wound care

  44. Guideline to Healthy Feet • Wash daily • Dry between toes • Lubricate dry feet • Inspect • Mirror • Family • Between toes

  45. Guideline to Healthy Feet • Avoid activities that i circulation • Smoking • Crossing legs • Tight socks

  46. Guideline to Healthy Feet • Good shoes • Comfortable • Closed toe • No bare feet • New shoes • Break in slowly

  47. Guideline to Healthy Feet • Prevent injuries • Wear socks • Cotton • Light color • No wrinkles • Check inside of shoe

  48. Guideline to Healthy Feet • No temperature extremes • Check bath water • No water bottles • No heating pads

  49. Guideline to Healthy Feet • See doctor regularly • Podiatrist • Trim straight across • Do not cut calluses or corns

  50. Guideline to Healthy Feet • Range of Motion

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