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Medical Surgical Nursing

Medical Surgical Nursing. Diabetes Mellitus. Endocrine Pancreas. Islets of Langerhans Beta cells Insulin. Insulin. Produced and secreted by … Beta cells. Insulin. Primary function … Stimulates the active transport of glucose from the blood into muscle, liver and adipose tissue 

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Medical Surgical Nursing

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  1. Medical Surgical Nursing Diabetes Mellitus

  2. Endocrine Pancreas • Islets of Langerhans • Beta cells • Insulin

  3. Insulin • Produced and secreted by… • Beta cells

  4. Insulin • Primary function… • Stimulates the active transport of glucose • from the blood into muscle, liver and adipose tissue  • __?__ blood glucose levels • i

  5. Glucose Content of Food • Consume food  glucose  blood stream • *Carbohydrates • Starch • Simple • Complex

  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

  7. The major action of insulin • i blood glucose levels • h the permeability of target cell membrane to glucose • Main target cells • Muscle • Liver • Adipose tissue

  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

  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

  10. Function of Insulin • Need insulin for glucose to cross cell membrane • No insulin  no glucose into the cell • Glucose stays in the blood  • Hyperglycemia

  11. Diagnostic tests • Blood glucose / Fasting blood glucose • Glycosylated Hemoglobin Assay

  12. 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

  13. Fasting Blood GlucoseNursing Responsibility • Fast 6-8 hours • Water OK • No insulin or anti-diabetic meds • Exercise will effect results

  14. Glycosylated Hemoglobin Assays (Hgb A1C) • % of glycosylated hemoglobin • RBC lifecycle • @ 120 days (4 months) • Glucose slowly binds with Hgb  glycosylated • h serum glucose level  h glycosylated Hgb levels

  15. Hgb A1C • Provides an average blood glucose levels • Past 2-3 months • Can be taken any time

  16. Normal levels (non-diabetic) • 4-6% • Diabetic level (goal) • <8%

  17. Small group questions • What are the Islets of Langerhans? • What cells of the pancreas secrete insulin? • What stimulates insulin to be secreted?

  18. What is diabetes mellitus? • Group of disordered characterized by chronic hyperglycemia • Due to faulty insulin production • (Not Diabetes Insipidus)

  19. Type 1 – Diabetes Mellitus • Destruction of the Beta cells • Result in • NO insulin production • Insulin dependent

  20. S&S of Type 1 DM • Hyperglycemia • ↑ blood glucose levels • No insulin  • Glucose stays in the blood stream

  21. S&S of Type 1 DM • Glycosuria • Glucose in the urine

  22. S&S of type 1 DM • Polyuria • Nocturia

  23. S&S of Type 1 DM • Polydipsia • Excessive thirst

  24. S&S of Type 1 DM • Polyphagia • Excessive hunger

  25. S&S of Type 1 DM • Dehydration • Assessment? • Skin turger • Mucus membranes • Thirst • BUN level

  26. Small Group Questions • Why would a person with high glucose levels have polyphagia? • Explain why polyuria is a common symptom of diabetes Mellitus Type 1. • What is hyperglycemia? • Why does hyperglycemia happen in Type 1 diabetes mellitus?

  27. Small Group Questions 5. What is a normal level for a FBS? 6. Define the following terms: Glucose, Glycosuria. 7. What does an Hgb A1c measure? What are normal values for a diabetic and non-diabetic?

  28. Type 2 DM • Pathophysiology • The pancreas cannot produce enough insulin for body’s needs • Impaired insulin secretion

  29. Type 2 DM • Weakened Beta cells Due to over use

  30. Insulin and Type 2 DM • Not all clients require insulin • 1/3 will at some time • Stress • Illness

  31. Risk Factors for Type 2 DM • Family history • Obesity • Gestational diabetes or large baby

  32. Type 1 vs. Type 2 • Age of onset • Usually < 30 • Age of onset • Usually > 40

  33. 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

  34. Type 1 vs. Type 2 • Management • Insulin • Diet • Exercise • Management • Diet (wt. Loss) • Exercise • Possibly oral hypoglycemic meds • Possibly insulin

  35. Other specific types of Diabetes Mellitus • Gestational • Pancreatitis • Drug or chemical induces diabetes (steroids)

  36. S&S of Diabetes Mellitus • Definition: • A group of disorders characterized by chronic Hyperglycemia • 3 P’s • Polydipsia • Polyuria • Polyphagia

  37. S&S of Hyperglycemia • Neurological • C/O headache • Dull senses • Stupor • Drowsy • Blurred Vision

  38. S&S of Hyperglycemia • Cardiovascular • Tachycardia • Decreased BP • (Dehydration) • Respiratory • Kussmaul's respirations • Sweet and fruity breath • Acetone breath

  39. S&S of Hyperglycemia • Gastro-intestinal • Polyphagia • N/V • Polydipsia

  40. S&S of Hyperglycemia • Genital-urinary • Polyuria • Glycosuria • Skeletal-muscular • Weak

  41. S&S of Hyperglycemia • Integumentary • Dry skin • Flushed face

  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.

  43. Small group questions • What question did the nurse most likely ask? • Why was Mr. McMillan fatigued? • Why was he dehydrated?

  44. Medical Management of DM • No cure • Goal is Control! And prevent complications • Individualized treatment plans • Diet • Exercise • Meds

  45. Dietary management of DMFoundation 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

  46. The exchange system • Six categories • Starch • Meat • Milk • Vegetable • Fruit • Fat

  47. General guidelines of Dietary Management • Protein • 20% • Fat • 20% • Carbohydrates • 60% • ADA: American Diabetic Association

  48. Diabetic Meal Plan • Small frequent meals • CONSISTENCY! • Amount of calories • Amount of carbohydrates • Time • Snacks

  49. Diabetic Meal Plan • If the client is obese, the key to treatment is… • Weight loss!

  50. Meal Planconsiderations • Food preferences • Lifestyle • Schedule • Ethnic / Cultural background

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