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DIABETIC NEUROPATHY (Causes (Diabetic neuropathy is caused by high blood…
DIABETIC NEUROPATHY
Causes
Diabetic neuropathy is caused by high blood sugar levels sustained over a long period of time
damage to the blood vessels caused by high cholesterol levels
mechanical injury, such as injuries caused by carpal tunnel syndrome
ifestyle factors, such as smoking or alcohol use
Low levels of vitamin B-12
Metformin, a common medication used to manage diabetes, can decrease levels of vitamin B-12.
Diagnostic Procedures
Acquiring medical history
Physical examination
Filament test
Sensetivity Test
Vital signs
Ankle reflex test
Classification
Peripheral Neuropathy
The most common form of neuropathy is peripheral neuropathy. Peripheral neuropathy usually affects the feet and legs, but it can also affect the arms or hands. Symptoms are varied, and can be mild to severe
Symptoms
numbness
tingling or burning sensations
extreme sensitivity to touch
insensitivity to hot and cold temperatures
sharp pain or cramping
muscle weakness
loss of balance or coordination
Autonomic Neuropathy
The second most common type of neuropathy in people with diabetes is autonomic neuropathy.
The autonomic nervous system runs other systems in your body over which you have no conscious control. Such as digestive system,sweat glands,bladder,sexual organs
Digestive Problems
constipation
diarrhea
swallowing trouble
gastroparesis, which causes the stomach to empty too slowly into the small intestines
Sexual and Bladder problems
Autonomic neuropathy may also cause sexual problems, such as erectile dysfunction, vaginal dryness, or difficulty achieving orgasm. Neuropathy in the bladder can cause incontinence or make it difficult to fully empty your bladder.
Cardiovascular Problems
Damage to the nerves that control your heart rate and blood pressure can make them respond more slowly. You may experience a drop in blood pressure and feel lightheaded or dizzy when you stand up after sitting or lying down, or when you exert yourself. Autonomic neuropathy can also cause an abnormally fast heart rate.
Proximal Neuropathy
A rare form of neuropathy is proximal neuropathy, also known as diabetic amyotrophy. This form of neuropathy is more commonly seen in adults over 50 years old with fairly well controlled type 2 diabetes, and more often in men.
It often affects the hips, buttocks, or thighs. You may experience sudden and sometimes severe pain. Muscle weakness in your legs may make it difficult to stand up without assistance. Diabetic amyotrophy usually affects only one side of the body.
Focal Neuropathy
Focal neuropathy, or mononeuropathy, occurs when there’s damage to one specific nerve or group of nerves, causing weakness in the affected area. This occurs most often in your hand, head, torso, or leg. It appears suddenly and is usually very painful.
Symptoms
pain, numbness, tingling in fingers
an inability to focus
double vision
aching behind the eyes
Bell’s palsy
pain in isolated areas, such as the front of the thigh, lower back, pelvic region, chest, stomach, inside the foot, outside the lower leg, or weakness in big toe
Nursing Mangement
The nurse should teach the patient on the preventitive measures that can be taken
Nurse should teach the patient about the importance of medication compaince
The nurse should give relevant H/E
Medical Mangement
Anti-seizure drugs. Some medications used to treat seizure disorders (epilepsy) are also used to ease nerve pain. The American Diabetes Association recommends starting with pregabalin (Lyrica). Others that have been used to treat neuropathy are gabapentin (Gralise, Neurontin) and carbamazepine (Carbatrol, Tegretol). Side effects may include drowsiness, dizziness and swelling.
Anti Depressants
Tricyclics, including amitriptyline, desipramine (Norpramin) and imipramine (Tofranil), may provide relief for mild to moderate symptoms. But side effects can be bothersome and include dry mouth, sweating, weight gain, constipation and dizziness.
Definition
Diabetic neuropathy is a serious and common complication of type 1 and type 2 diabetes. It’s a type of nerve damage caused by long-term high blood sugar levels. The condition usually develops slowly, sometimes over the course of several decades.
Signs and Symptoms
sensitivity to touch
loss of sense of touch
difficulty with coordination when walking
numbness or pain in your hands or feet
burning sensation in feet, especially at night
muscle weakness or wasting
bloating or fullness
nausea, indigestion, or vomiting
diarrhea or constipation
dizziness when you stand up
excessive or decreased sweating
bladder problems, such as incomplete bladder emptying
vaginal dryness
erectile dysfunction
inability to sense low blood glucose
vision trouble, such as double vision
increased heart rate
Health Education
Check your feet every day. Look for blisters, cuts, bruises, cracked and peeling skin, redness, and swelling. Use a mirror or ask a friend or family member to help examine parts of your feet that are hard to see.
Keep your feet clean and dry. Wash your feet every day with lukewarm water and mild soap. Avoid soaking your feet. Dry your feet and between your toes carefully by blotting or patting with a soft towel.
Moisturize your feet thoroughly to prevent cracking. Avoid getting lotion between your toes, however, as this can encourage fungal growth.
Trim your toenails carefully. Cut your toenails straight across, and file the edges carefully so there are no sharp edges.
Wear clean, dry socks. Look for socks made of cotton or moisture-wicking fibers that don't have tight bands or thick seams.
Wear cushioned shoes that fit well. Always wear shoes or slippers to protect your feet from injury. Make sure that your shoes fit properly and allow your toes to move. A podiatrist (foot doctor) can teach you how to buy properly fitted shoes and to prevent problems such as corns and calluses.
Pathophysiology
Diabetic neuropathy occurs when there is an imbalance between nerve fiber damage and repair. The nerve damaging process preferentially affects autonomic and distal sensory fibers, leading to the progressive loss of sensation. Ischemic factors and inflammation also contribute to the development of diabetic neuropathies. Metabolic factors seem to prevail in length-dependent diabetic polyneuropathy, whereas inflammation superimposed on ischemic nerve lesions is found in severe forms of focal neuropathies. The thickening and hyalinization of the walls of small blood vessels due to the reduplication of the basal lamina around endothelial cells suggests a role for nerve ischemia in diabetic neuropathy. There is also a reduction in endoneurial oxygen tension in the sural nerves of diabetic patients with advanced polyneuropathy
Nursing Care Plan
Risk of Acute Pain
Expected Outcomes
Verbalizes pain relief methods
Displays improved vital signs and muscle tone
Nursing Interventions
Perform a comprehensive assessment. Assess location, characteristics, onset, duration, frequency, quality and severity of pain.
Observe for nonverbal indicators of pain: moaning, guarding, crying, facial grimace.
Obtain Vital SIgns
Assess the client’s current use of medications.
Use nonpharmacological pain relief methods (relaxation exercises, breathing exercises, music therapy).
Provide optimal pain relief by administering prescribed pain relief medication.
Nursing Diagnosis
Injuring agents (biological, chemical, physical, psychological)
Evaluation
Assess patients relief