Mrs. April Page, ARNP MSN FNPC NUR1213C Intermediate Adult Care Diabetes Mellitus: Sick Day Management, Foot Care and Patient Education Chapter 64 – Care of Patients with Diabetes: Mrs. April Page, ARNP MSN FNPC NUR1213C Intermediate Adult Care

Sick Day Management & Patient Education A bad cold, flu, or minor gastrointestinal upset can create problems for diabetic patients.

Care and Management for Diabetic Patients Sick Day Management

Medication Take insulin as prescribed. Adjust the dosage as directed, depending on blood glucose readings. If taking an oral hypoglycemic, take usual dose. Do not increase the dose unless ordered to do so by the health care provider. If vomiting and unable to take medication by mouth, the health care provider may temporarily prescribe insulin.

Diet Eat a normal diet on schedule. If nausea and vomiting occur, replace carbohydrate solid foods in the normal diet with liquids that contain sugar (fruit juice, regular soft drinks, or Jell-O). Take at least 1 cup of water or calorie-free, caffeine-free liquid each hour. If nauseated, take small sips to help prevent vomiting.

Monitoring Test blood glucose at least every 4 hours and record result. If severely ill, check blood glucose every 2 hours. Test urine for ketones if blood sugar level is higher than 300 mg/dL.

Notifying the Health Care Provider Call the health care provider right away for vomiting or abdominal pain or a temperature higher than 100.2° F (38.8° C). Notify the health care provider if blood glucose is higher than 200 mg/dL or if urine test shows ketones. Report to the health care provider if blood glucose level that was higher than 200 mg/dL does not come down with an additional dose of insulin. If unable to reach the health care provider, go to the hospital emergency department.

Care and Management for Diabetic Patients Diabetic Foot Care

Importance of Foot Care Learning and practicing excellent foot care are essential to prevent amputation. Multiple studies have identified early identification and intervention as tools to successfully prevent amputation

Foot Care Inspect each foot daily for cuts, cracks, blisters, abrasions, or discoloration of the toes; report any abnormality to the health care provider. Use a mirror if unable to bend to see the bottom of the foot. Be certain to check between the toes. Wash the feet in warm (not hot) water, using mild soap; do not soak the feet, because this can cause cracking of the skin. Thoroughly dry the feet after washing, paying special attention to drying between the toes. Rub in a non-scented, non-medicated cream if the skin is dry; do not put the cream between the toes.

Foot Care (Cont.) Cut the nails along the shape of the toe and file the nails to remove sharp edges. Have corns, calluses, and ingrown nails managed by a podiatrist. Wear a clean pair of cotton socks each day. Wear properly fitted shoes with a firm sole that do not pinch or bind the foot; never walk barefoot. Break in new shoes gradually. Never wear open sandals or sandals with straps between the toes.

Foot Care (Cont.) Never wear open sandals or sandals with straps between the toes. Use socks and blankets to warm the feet; do not use a heating pad or hot water bottle near them. Test the temperature of bath water with wrist or forearm before stepping into the tub or shower. Elevate the feet whenever possible to improve circulation.

Outcome Criteria for Diabetes Teaching

Before being discharged to home, the patient with diabetes or the significant other should be able to (Chart 64-15, page 1339): Tell why insulin or an oral hypoglycemic agent is being prescribed Name which insulin or oral hypoglycemic agent is being prescribed, and name the dosage and frequency of administration Discuss the relationship between mealtime and the action of insulin or the oral hypoglycemic agent Discuss plans to follow diabetic diet instructions Prepare and administer insulin accurately

Before being discharged to home, the patient with diabetes or the significant other should be able to (Chart 64-15, page 1339) (Cont’d): Test blood for glucose, or state plans for having blood glucose levels monitored Test urine for ketones, and state when this test should be done Verbalize how to store insulin List manifestations that indicate a hypoglycemic reaction Tell what carbohydrate sources are used to treat hypoglycemic reactions

Before being discharged to home, the patient with diabetes or the significant other should be able to (Chart 64-15, page 1339) (Cont’d): Tell what manifestations indicate hyperglycemia Tell what dietary changes are needed during illness Verbalize when to call the physician or the nurse (frequent episodes of hypoglycemia, manifestations of hyperglycemia)  Verbalize the procedures for proper foot care

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