Diabetes Mellitus

Diabetes Mellitus

Cardinal S/Sx

Factors Diagnostic
exams

Nursing
Diagnosis

Health
teaching

- is a group oI
metabolic diseases in
which a person has
high blood sugar,
either because the
body does not produce
enough insulin, or
because cells do not
respond to the insulin
that is produced

DKA- is caused by an
absence or markedly
inadequate amount oI
insulin. This deIicit in
available insulin
results in disorders in
the metabolism oI
carbohydrate, protein,
and Iat.

HYPERGLYCEMIC
HYPEROSMOLAR
NONKETOTIC
SYNDROME- Fluid
moves Irom inside to
-polyuria, polydipsia,
polyphagia
-slowed wound healing
-weakness and paresthesia
-Microvascular:
retinopathy, neuropathy,
nephropathy
-Macrovascular: coronary
artery disease,
cardiomyopathy,
hypertension

DKA: (DM I)
- yperglycemia
- Dehydration and
electrolyte
imbalance
- Acidosis
-
HHNS (DM II)
- ypotension
-ProIound dehydration (dry
mucous membranes, poor
skin turgor)
-tachycardia
-variable neurologic signs
Predisposing
factors:
Type I: Onset
any age, but
usually young
(30 yrs),
genetic,
immunologic

Type II: Onset
any age,
usually over 30
years, heredity

Precipitating
factors:
Obesity,
Sedentary
liIestyle

DKA:
Omission oI
insulin;
physiologic
stress
(inIection,
-FBS (fasting
blood sugar)/
FBG (fasting
blood glucose)
DM: ~126
mg/dl Ior 2
readings
Pre:
-Patient should
Iast Ior at least
8 hours.
-Red top tube

Post:
-Instruct the
patient to
resume usual
diet, as
directed by the
health care
practitioner
once blood
extraction is
done.


1. Fluid volume
deIicit r/t
osmotic
dieresis Irom
increased blood
glucose level

2. Risk Ior
inIection r/t
high glucose
levels in blood


3. DeIicient
knowledge
related to
diabetes selI-
care

EXTRA :
*nutrition: less
than body
requirements
-Strict
adherence to
DM
management

-Do not
abruptly stop
OA

-Encourage
to provide
support
system to the
clients
(including
Iinancial)

- explain to
the Iamily
about the
therapeutic
compliance
oI the patient
outside cell causing
dieresis and loss oI
Na and K

(eg, alteration oI
sensorium, seizures,
hemiparesis)


surgery, CVA,
MI)
HHNS:
Physiologic
stress
(inIection,
surgery, CVA,
MI)



DKA: Usually
~250 mg/dL
(~13.9
mmol/L)


HHNS:
Usually ~600
mg/dL
(~33.3
mmol/L)


-Glycosylated
Hgb (hba1c)
Diabetes well
controlled:
2.56;
Diabetes not
well
controlled:
~8

Pre:
-Lavender top
tube
-InIorm the
patient that the
test is used to
assess long-
term glycemic
control (past 3
months).

-There are no
Iood, Iluid, or
medication
restrictions,
unless by
medical
direction.
-assess iI the
patient has
undergone
blood
transIusion in
the past 120
days

Post:
Monitor
Iindings:
Decreased
levels
can be caused
by anemias,
long-term
blood loss, and
chronic
renal Iailure.
Increased
levels may
result Irom
hyperglycemia,
alcohol
ingestion,
pregnancy,
hemodialysis,
and prolonged
cortisone
intake.



Serum
Osmolality
DKA: 300
350 mOsm/L
HHNS: ~350
mOsm/L












Assessment Diagnosis Planning Intervention/Rationale Evaluation
O: dry skin and
mucuos membrane

Capillary reIill
~3seconds

Poor skin turgor

Orthostatic
ypotension ( Iall
in BP when the
person stands up or
stretche )

yperventilation
Kussmaul
respiration heard
upon auscultation

lethargy

Flushed skin

Polyuria

Diarrhea

vomiting
Fluid volume
deIicient relared to
osmotic diuresis
Irom
hyperglycemia as
maniIested by

-dry skin and
mucuos membrane

-Poor skin turgor

- Capillary reIill
~3seconds


- Orthostatic
ypotension

-Thirst

-lethargy

-Ilushed skin

Polyuria

Diarrhea

vomiting

AIter 8 hours oI
nursing
intervention,
patient will be able
to demonstrate
adequate hydration
as evidenced by
good skin turgor,
moist skin and
mucous membrane
Independent:
1. Monitor
orthostatic
blood pressure
changes and
heart rate.
Monitoring of
fluid volume
status.

2. Monitor
repirations.
ussmaul
breathing
represents
bodys attempt
to decrease
acidosis.


3. Monitor Ior
signs oI Iluid
overload. %his
is important for
older patients,
renal
impairment and
heart failure.

4. eigh daily.
!rovides best
assessment of
current fluid
AIter 8 hours oI
nursing
interventions, the
patient was able to
demonstrate
adequate hydration
as evidenced by
moist mucous
membrane, good
skin turgor and
good capillary
reIill.
status and
adequacy of
fluid

5. Maintain
Iluidintake at
least 2500ml a
day with cardiac
tolerance with
oral intake as
resumed.
Maintains
hydration and
circulating
volume.

6. Promote
comIortable
environment.
Cover patient
with light
sheets. voids
overheating
which could
promote further
fluid loss.

Dependent.

7. Admininster IV
Iluids 6-10
liters. PNSS,
usually 0.5 L to
1 L per hour Ior
2 to 3 hours.
ypotonic
Saline solution
Ior those at risk
oI heart
Iailure..to
replace fluid
losses.
hen the blood
glucose reaches
300mg/dl or
less, IV Iluid
may be change
to D5 to
prevent
precipitous
decline in blood
glucose level.

8. Plasma
expanders may
be necessary to
correct severe
hypotension
that does not
respond to IJ
fluids.