1. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Chapter 64-Iggy Pg 1300-1323 Care of Patients with Diabetes Mellitus

2. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Objectives Describe basic pathophysiology in relation to DM Type I/II Identify selected medications utilized in treatment of DM Type I/II Discuss geriatric considerations State nursing interventions and patient education necessary to manage disease 2

3. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Insulin Physiology 3

4. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Types of Diabetes Type 1 Type 2 Gestational (GDM) Other specific conditions resulting in hyperglycemia 4

5. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Absence of Insulin Hyperglycemia Polyuria Polydipsia Polyphagia Ketone bodies Hemoconcentration, hypovolemia, hyperviscosity, hypoperfusion, and hypoxia Acidosis, Kussmaul respiration 5

6. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Chronic Complications of Diabetes Macrovascular/microvascular disease Retinopathy (vision problems) Nephropathy (kidney dysfunction) Neuropathy (nerve dysfunction) 6

7. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Macrovascular Complications Cardiovascular disease Cerebrovascular disease 7

8. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Microvascular Complications Eye and vision complications Diabetic neuropathy Diabetic nephropathy Male erectile dysfunction 8

9. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Metabolic Syndrome Also called syndrome X Classified as simultaneous presence of metabolic factors known to increase risk for developing type 2 diabetes and cardiovascular disease Symptoms 9

10. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Health Promotion & Maintenance Control of diabetes and its complications is major focus for health promotion activities 10

11. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Assessment History Blood tests Fasting plasma glucose (FPG) Oral glucose tolerance test (OGTT) Other blood tests Screening Ongoing assessment – Glycosylated hemoglobin assays, glycosylated serum proteins and albumin, urine tests, tests for kidney function 11

12. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Treatment Options Medication therapies Insulin Nutritional considerations Exercise Surgical intervention (such as transplantation) 12

13. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Patient Education Insulin storage Dose preparation Syringes Blood glucose monitoring Infection control measures Diet therapy 13

14. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Summary Patient with a Diabetic Condition 1.Etiologies, risk factors, comorbidities 2.Assessment findings 3.Diagnostic tests 4.Nurse’s role 5.Interdisciplinary team’s role 6.Treatment/intervention priorities 7.Teaching/health promotion information 8.Community resources 14