Nursing Case Study Example Diabetes

Nursing Case Study Example Diabetes

The prevalence of diabetes varies greatly from population to population and throughout the whole wide world. As much as there is an increase in prevalence of the condition, many people have not had their condition diagnosed and treated. The knowledge about diabetes is essential for prevention and management and therefore people should be educated about complications that are associated with diabetes and how to manage it.  With proper treatment and healthy living, many patients can live a long and comfortable life. This article explores the complications, diagnosis, types, treatment, and other questions that help raise awareness.

Nursing Case Study Example Diabetes
Nursing Case Study Example Diabetes

Identify systemic complications associated with diabetes mellitus.

Retinopathy

Nephropathy

Neuropathy

Cardiovascular disease

Peripheral vascular disease

Periodontal disease

State the diagnostic criteria for diabetes mellitus.

Fasting plasma glucose ≥ 126 b. Oral glucose tolerance after 2 hours ≥ 200 c. HbA1c ≥ 6.5 Random plasma glucose w/ symptoms ≥ 200

Compare and contrast the pathophysiology of diabetes type 1, type 2, and gestational diabetes.

Type 1 – autoimmune destruction of β cells in pancreas → absolute insulin deficiency

Type 2 – insulin resistance → beta cells overproduce insulin → burn out cells → relative

to insulin deficiency

May develop absolute deficiency later in disease

Gestational – similar to type 2, but due to placental hormones → insulin resistance

Predisposes to type 2 later in life

Distinguish the treatment of diabetes type 1 versus type 2.

Type 2 – oral meds to increase insulin release or sensitivity ( to target beta cells) + lifestyle

changes

Type 1 – insulin therapy +/- amylin injections

  1. State the prevalence of diabetes mellitus in the U.S.

20.8 million people b. 7% of U.S. population

Compare the prevalence of diabetes type 1 and type 2.

Type 1 – 5-10%

Type 2 – 85-90%

Identify oral manifestations of diabetes mellitus.

  1. Burning mouth syndrome b. Candidiasis c. Dental caries d. Gingivitis e. Glossodynia ( burning of the mouth with no obvious cause) f. Lichen planus g. Neurosensory dysesthesias periodontitis h. Salivary dysfunction i. Taste dysfunction j. Xerostomia

Describe the relationship between diabetes mellitus and periodontitis.

Patients with severe periodontitis are more likely to have uncontrolled diabetes in the future, as

well as increased risk for cardio & renal disease

  1. Poorly controlled diabetes, → increased occurrence & severity of periodontitis
  2. Increased blood glucose → formation of advanced glycation end products →

binding to RAGEs on macrophages & endothelial tissue → exaggerated

inflammatory response

  1. Enhanced apoptosis → reduced wound healing
  2. Periodontal disease also releases inflammatory cytokines into microcirculation, which can

reach distant sites

  1. Antagonize insulin ii. Promote inflammation elsewhere

Recognize the common systemic signs and symptoms associated with diabetes mellitus.

New-onset polyuria & nocturia ( night)

Polydipsia ( drink a lot ) c. Unexplained weight loss d. Blurred vision, tiredness

Describe the epidemiology of diabetes mellitus.

20.8 million (7%) of the U.S. population has D.M.

1.5 million new cases in 2005 ii. 10-15% of the U.S. population has prediabetes

Complications take about ten years to develop & occur in 30% of D.M. patients

Identify risk factors for diabetes mellitus.

Type

13% chance if mom has it,

6% chance if dad

30-50% chance b/w monozygotic twins

  1. Type 2 – stronger than type 1
  2. 40% have a parent w/D.M. 2. First-degree relative → 5-10x higher risk of D.M. 3. 60-90% chance b/w monozygotic twins
  3. Type 1

Loss of pancreatic tissue – surgery, infection, cystic fibrosis

Low vitamin D 3. Autoantibodies

  1. Type 2

Obesity/overweight, inactive, high B.P., high cholesterol

Ethnicity – African-Americans, Hispanic Americans, Native Americans, Asian

Americans, Pacific Islanders @ higher risk

Previous gestational diabetes

Age

PCOS ( Polycystic ovary syndrome )

Discuss issues and precautions associated with dental implant surgery in diabetic patients.

If controlled, a high success rate is possible

If the uncontrolled, increased risk of failure

Hyperglycemia reduces bone formation & remodeling → reduces osseointegration of implants

Hyperglycemia compromises microvasculature → delayed wound healing &

increased infection

Precautions

Use antibiotics ii. Adjust insulin

Monitor glycemic control iv. Use chlorhexidine mouthwash

Communicate w/ physician vi. Caution w/ epi

Treat in the morning & after a meal viii. Hydroxyapatite coated = better success rate

Identify common classes of oral anti-diabetic drugs.

Biguanides – metformin

Keep liver from making more glucose

Sulfonylureas

Increase insulin release from the pancreas

Meglitinides

Increase insulin release from the pancreas

Thiazolidinediones

Increase glucose uptake by fat & muscle

α-glucosidase inhibitors

Prevent carb digestion

where is the pancreas located

the head of the pancreas nestles into the curve of the duodenum, the first portion of the small intestine

what are the exocrine functions of the pancreas

digestive enzyme production

what are the endocrine functions of the pancreas

insulin and glucagon production

what cells produce glucagon

alpha cells: raise blood glucose levels

which cells produce insulin

beta-cells: lowers blood glucose levels

normal blood pH level

7.35-7.45

pH scale

0-7 acidic (more H+)

Seven neutral

8-14 alkaline (more O.H.-)

what is a chemistry panel

groups of tests that are ordered to determine a person’s general health status

urinalysis

examination of urine (checks for WBC, RBC, glucose, etc.) also detects kidney and other organ functions

which results from the chemistry panel would be abnormal with diabetes

K (potassium)

glucose

BUN

results of the chemistry panel

k = 5.9 (3.5-4.9)

glucose = 659 (70-110)

BUN = 29 (7-24)

why are the chemistry panel results abnormal

k= electrolyte imbalance

glucose= high Blood sugar

BUN= stress on the kidneys

systolic pressure

the force of blood pushing against the walls of arteries as the heart pumps blood

diastolic pressure

when the heart is at rest

what can cause hypertension

age, family history, genetics, unhealthy lifestyle

hypertension

high blood pressure

hypotension

low blood pressure

why are CO2 levels low in patients in DKA

hyperventilating blows off CO2 to try to lower acidity levels in the blood

why do patients with DKA hyperventilate

to blow off extra CO2

stages of DKA

no insulin

the body can’t use sugar for energy

use fat for energy instead

waste products for breaking down fat is ketons

  1. buildup of ketons leads to high blood acidity

what is DKA

diabetic ketoacidosis

diabetes

conditions where blood glucose levels are elevated

type 1 diabetes

a chronic disease where cells in the pancreas that make insulin are destroyed, and the body is unable to produce insulin

type 2 diabetes

the cells have stopped responding to insulin. the body struggles to move glucose from the blood to the cells

symptoms of untreated diabetes

excessive hunger

excessive thirst

blurred vision

fatigue

frequent urination

dramatic weight loss

complications of diabetes

increased heart attack risk

eye problems, including blindness

nerve damage

infections on skin

kidney damage

what is diabetic ketoacidosis

when there is not enough insulin, the body can’t use sugar for energy, so it uses fat instead

symptoms of hyperglycemia

increased thirst/hunger, frequent urination, glucose in urine, headache, fatigue, blurred vision

symptoms of hypoglycemia

shaky/jittery, sweaty, hungry, headache, blurred vision, sleepy/tired, dizzy/lightheaded

ways you can become hyperglycemic

overeating sugar or not taking enough insulin

ways you can become hypoglycemic

taking too much insulin for what you’re eating

what is a complication of hypoglycemia

DKA

what is a complication of hyperglycemia

Hyperosmolar hyperglycemic nonketotic syndrome (HHNS)

why is a dietician important to a patient with diabetes

to have healthy eating habits and the amount of insulin you need depends on how much/what you’re eating

who performs an arterial blood gas test

respiratory therapist

what does the arterial blood gas test detect

acid-base imbalance

pancreatic islets/islets of Langerhans

pancreatic tissue that contains beta cells that produce insulin

orangomegaly

enlargement of visceral organs

Risk Factors – Diabetes

Obesity

Advanced Age

Glucose Intolerance

Family history

Gestational diabetes

Sedentary lifestyle

Pancreatitis or pancreatic cancer

Certain infections

Signs and Symptoms – Diabetes

Glycosuria

Polyuria

Prolonged wound healing

Polyphagia

Ketoacidosis

Fatigue

Polydipsia

Recurrent infections

Weight loss

What is the main sign/symptom of diabetes?

Hyperglycemia

Diabetic Foot Complications

Edema

Infection

Ischemia

Ulcers

Fallen arches

Hammer’s toe

Charcot’s joints

Type 2 diabetes definition

Insufficient insulin production/resistance

Type 1 diabetes definition

Total insulin deficiency

Complication – Glycosylation definition

Glucose is deposited into the basement membrane of blood vessels and neurons

Complication – How does excess glucose cause polyuria?

Glucose transporters become saturated, remaining infiltrated. This glucose causes an osmotic gradient, drawing more water into the filtrate

What are the consequences of polyuria?

Polydipsia

With prolonged fluid deprivation, plasma osmolarity will cause a fluid shift = cellular dysfunction

Glycosylation effects

Affects transportation of substances in and out of blood = Tissue ischemia, Poor inflammatory response. Poor wound healing, Recurrent infection, Affects action potential conduction

Glycosylation complications

Neuropathies

Retinopathies

Nephropathies

Macular oedema definition

Fluid leaks into the retina, creating swelling and blurred vision

Proliferative retinopathy definition

Fragile, abnormal blood vessels form but break quickly, causing hemorrhages, scarring, retinal detachment

Nephropathy definition

Microvascular damage affects glomeruli

Autonomic neuropathy definition

Nerve damage in autonomic N.S., caused by glycosylation affecting action potentials

Autonomic neuropathy complications

G.I. issues – delayed gastric emptying, diarrhea, constipation

Erectile dysfunction

Postural hypotension

Urinary problems – infections, incontinence

Peripheral neuropathy complications

Decreased wound healing

Numbness in peripheries

Increased risk of infection/injury

Diabetic Foot Complications

Edema

Infection

Ischemia

Ulcers

Fallen arches

Hammer’s toe

Charcot’s joints

Autonomic neuropathy complications

G.I. issues – delayed gastric emptying, diarrhea, constipation

Erectile dysfunction

Postural hypotension

Urinary problems – infections, incontinence

Discuss issues and precautions associated with dental implant surgery in diabetic patients.

If controlled, a high success rate is possible

If the uncontrolled, increased risk of failure

Hyperglycemia reduces bone formation & remodeling → reduces osseointegration of implants

Hyperglycemia compromises microvasculature → delayed wound healing &

increased infection

Management of diabetes

Medication

Lifestyle changes – physical activity, smoking cessation

Dietary changes

What is the HbA1c test?

Glycosylated Hemoglobin levels. Measures average plasma glucose concentration over the past three months.

What is the normal (non-diabetic) blood glucose range?

3-8 mmol/L

Metformin action, effect, route

biguanide hypoglycemic medication

decreases gluconeogenesis and increases peripheral uptake/utilization of glucose

Oral

Humulin (human neutral insulin) action, effect, route

Long-acting insulin

Facilitates glucose uptake into cells, converts the excess into fat, inhibits lipolysis, enhances protein synthesis

Subcut

Humalog (insulin lispro) action, effect, route

Rapid onset, short-acting insulin

Facilitates glucose uptake into cells, converts the excess into fat, inhibits lipolysis, enhances protein synthesis

Subcut

Glipizide action, effect, route

Stimulates insulin production by the pancreas

Lowers blood glucose level

Describe the pathogenesis and pathophysiological changes associated with diabetes.

The pathophysiology of type 2 diabetes mellitus is characterized by peripheral insulin resistance, impaired regulation of hepatic glucose production, and declining β-cell function, eventually leading toβ -cell failure.

Describe the principles behind monitoring physiological parameters and sampling for laboratory tests as they relate to the diagnosis of diabetes and controlling blood glucose.

In decentralized screening, fasting blood glucose is the appropriate analyte, followed by retesting FPG and/or by urine glucose. The comparability of glucose analyses must be verified by internal and external quality control. HbA1c may also be used in decentralized screening, although the results may vary when different chromatographic methods are used. The OGTT is not recommended as the first screening step but rather as a confirmation test.

Explore some of the pharmacological agents used in Carol’s care.

Insulin pump-she describes the benefits of getting very small, continuous doses of insulin from a pump as opposed to larger doses through pen injections.

mixed dose and mixed type insulin regime- one is rapid-acting insulin while the other is long-acting insulin

Demonstrate knowledge of the principles of preventative measures and therapeutic interventions in acute and complex care.

Assessment

Rationale

Vital signs

Assess heart rate, breathing, and temperature to compare with

Glucose levels

to assess whether carol is worse from the previous check

Abdominal assessment

due to pain being indicate in this area

funduscopic examination

check eyes

limited vascular and neurologic examinations

alertness and comprehensiveness

foot assessment.

circulation

Demonstrate a comprehensive knowledge of nursing practice management for clients experiencing hypo/hyperglycemia

Hyperglycemia Fruity-smelling breath. Nausea and vomiting. Shortness of breath. Dry mouth. Weakness. Confusion. Coma. Abdominal pain.

Hypoglycemia symptoms include sweating, shakiness, tachycardia, anxiety, and a sensation of hunger

Analyze issues related to health education for adults experiencing diabetes.

On how to improve their blood glucose control without a record.

Inconvenience to have to monitor their blood glucose levels

Discuss issues and precautions associated with dental implant surgery in diabetic patients.

If controlled, a high success rate is possible

If the uncontrolled, increased risk of failure

Hyperglycemia reduces bone formation & remodeling → reduces osseointegration of implants

Hyperglycemia compromises microvasculature → delayed wound healing &

increased infection

 

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