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Endocrine: Nursing (Nursing assessment and management of patient…
Endocrine: Nursing
- Nursing assessment and management of patient (hypo/hyperglycemia)
3 Ps 1. Polyuria 2. Polydipsia 3 Polyphagia - fatigue, weakness, vision changes, dry skin, skin lesions Diagnostic findings -Fasting BGL >7.0 mmol/L - Rand. glucose >11.1 - HbA1c >6.5%
Dietary management: - optimal nutrition - meet energy needs - maintain and achieve reasonable weight - prevent fluctuations in BGL - reduce serum lipids - enjoyment - consider food preferences, lifestyle, culture - diet history - caloric requirement - fibre - alcohol exercise: - lowers blood glucose - aids weight loss - lowers cardiovascular risk - maintain muscular strength and balance in older people - encourage daily exercise - slow gradual increase in excercise
ASSESSMENT: history - symptoms of hypo/hyperglycemia -frequency, timing, severity and resolution - BGL result - lifestyle physical exam: - functional and nutritional status - BP - BMI - neurological exam - oral exam diagnostic: - Random BGL - urinalysis (ketones, glucose)
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- Type 1 & 2 & Gestational diabetes: and risk factors
Type 1: - insulin-producing beta cells in pancreas are destroyed by an autoimmune process - requires insulin, as little/no insulin produced - onset: acute, 30 years old - 5-10% of diabetic population Type 2: - reduced sensitivity to insulin and impaired beta cell function resulting in reduced insulin production - 90-95% diabetic population - over 30 years, obesity - slow and progressive glucose intolerance - diet and exercise and medication = treatment Gestational : - glucose intolerance occurring during pregnancy - placenta hormones cause insulin resistance - mother and baby at risk of type 2 later in life - BGL usually return to normal after pregnancy
RISK FACTORS: type 1= not inherited, but genetic predisposition combined with immunological and possible environment and epigenetic precipitating factors. type 2 - family hist. - age - ethnicity - impaired glucose tolerance - hypertension - history of gestational diabetes - poor nutrition - physical inactivity - smoking -high BP - high cholestrol
- Short and long term complications of diabetes
acute complications - hypo/hyperglycemia - diabetic ketoacidosis (KDA) - hyperglycemia hyperosmolar states (HHS).
hypoglycemia - <2.7-3.3 mmol/L) - causes include too much insulin or GLM, too little food and excess physical activity TREATMENT: must be immediate - give 15g of fast-acting, concentrated carbohydrate - provide snacks DKA - due to absence of or inadequate insulin resulting in abnormal metabolism of carbohydrate, protein and fat. - range between 17-44 mmol/L - ketone bodies in blood and urine TREATMENT: - re-hydrate with IV fluid - monitor - restore electrolyte balance HHS - due to lack of effective insulin - ketosis is minimal or absent - high mortality TREATMENT: re hydrate - insulin administration
long term complications: - macrovscular complications - microvascular complications - neuropathic changes
INSULIN. rapid acting - 5 to 15 min - peal 1 hr after injection - duration 2 to 4 hrs short-acting - onset 30-60 mins - peak 2 to 3 hrs - duration of 4 to 6 hrs intermediate - onset 3 to 4 hrs - peak in 4 to 12 hrs - duration of 16 - 20 hrs - white/cloudy appearance very long acting - long, slow, sustained with no peak action time - duration approx. 24 hrs
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- Normal range of BGL & situations where appropraite to obtain BGL
Between 4.0 to 5.4 mmol/L (72 to 99 mg/dL) when fasting. Up to 7.8 mmol/L (140 mg/dL) 2 hours after eating.
- Indications for subcut and IM
- absorption occurs more rapidly with an injection than orally - IV injections absorbed more rapidly than IM - effects of IM last longer due to increased absorption time - patients unable to take med orally - medication is prone to malabsorption
- Anatomical sites for subcut and IM
IM sites: - ventrogluteal site - vastus lateralis site - deltoid muscle SUBCUT = subcutaneous tissue (abdomen)
-longer needle for IM than interdermal or subcut - viscosity of solution quantity to be administered - body size (obese person = longer needle) - type of medication
- Procedure for subcut and IM
- choose right needle - prepare medication - prepare site for injection -dispose of sharps after procedure