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NRS 220 Diabetes Mellitus Exemplar

This article provides an overview of diabetes mellitus, including definitions, assessments, complications, and treatment options. It discusses the different types of diabetes, symptoms of hyperglycemia and hypoglycemia, laboratory values, complications, and various treatment options including diet, exercise, medications, insulin therapies, insulin pumps, and pancreas transplants.

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NRS 220 Diabetes Mellitus Exemplar

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  1. Denise Coffey MSN, RN NRS 220 Diabetes Mellitus Exemplar

  2. Statistics • American Diabetes Association:www.diabetes.org • Nearly 26 million Americans have diabetes and an estimated 79 million U.S. adults have prediabetes‚ according to new estimates from the Centers for Disease Control and Prevention (CDC). • The National Diabetes Fact Sheet for 2011 says that diabetes affects 8.3 percent of all Americans and 11.3 percent among those aged 20 and older. An estimated 7 million Americans with diabetes do not know they have the disease!!

  3. The picture

  4. Definitions • Insulin: what is it’s function?? • Glucose: what is it’s function??

  5. Definitions • Type I –which is? • Type 2 –which is? • Gestational Diabetes (GDM) • Other specific conditions resulting in hyperglycemia

  6. Assessment • Hyperglycemia: what would you expect to see? • Lab work • Where do we want to see our patient’s lab values at?

  7. Assessment • Hypoglycemia: what are some signs and symptoms? • What are you going to do as the RN assigned to a patient experiencing hypoglycemia?

  8. Complications • Microvascular: you tell me! • Macrovascular: you tell me!

  9. Complications

  10. Assessment • 3 P’s: polyuria, polydipsia, polyphagia • Describe other assessment findings you would need to be on the look out for.

  11. What happens to our bodies when we are hyperglycemic? Blood Glucose >110 Insulin Resistance Decreased Insulin Increased Free Fatty Acid Oxidative Stress

  12. Oxidative Stress Nitric Oxide Nitric oxide Tissue factor Plasminogen Activator Prostaccyclin Nitric Oxide Angiotensin ll Endothelin-1 Activation of activator protein -l Angiotensin ll Vasoconstriction Inflammation Thrombosis hypertension Release of chemokines Release of cytokines Expression of cellular adhesion molecules Hyper coagulation Platelet Activation Decreased Fibrinolysis Vascular smooth muscle cell growth

  13. Increased Glucose Decreased Insulin Increase in: Ketones Free Fatty Acids Lactate Immune Dysfunction Reactive 02 Species Cellular Injury Inflammation Tissue Damage Altered Tissue Healing Acidosis Thrombosis Global Infarction Ischemia Infection Dissemination Increase Transcription Factors Leads to Secondary Meadiators

  14. Treatment options • Diet –what teaching would you provide to your patient? • Exercise • PO medications- what teaching would you provide to our patient • Insulin therapies

  15. Other treatment options • Insulin pumps • Pancreas transplant

  16. Planning & Implementation • Patient education: • What education would you need to make sure you patient receives?

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