Transcript Lecture 3C PowerPoint

Endocrine 3A
Part 3
Long Term Complications of Diabetes
• Macro vascular complications
– Arteriosclerosis
• Characterized by thickening and loss of elasticity of the arterial
walls “hardening of the arteries”.
– Coronary Artery Disease
– Cerebrovascular Disease
– Peripheral vascular disease
Coronary/cerebrovascular disease
Changeable risk factors
• Weight control
• Low-fat diet
• Treat hypertension
• Treat hyperlipidema
• Regular exercise
• Control blood glucose levels
• Smoking
• Diabetes
Unchangeable risk factors
• Age
• Gender
• Family history
• Race
Microvascular complications
• Characterized by basement membrane
thickening
• Effects smallest blood vessels
• Due to hyperglycemia
Diabetic Retinopathy
• Damage to the tiny
blood vessels that
supply the eye 
• Small hemorrhages
occur
• Damage is due to
hyperglycemia
Prevention
• Control
– Glucose
– BP
Prevention
•
•
•
•
No straining
Use laxatives
Avoid lowering head
Avoid lifting above
shoulders
Retinopathy:
Medical Management
• Photocoagulation
“laser” treatment
• Control hypertension
• Control blood glucose
• No smoking
Retinopathy:
Nursing Considerations
•
•
•
•
Expected
Odds are good
Frequent eye exams
Bilateral but uneven
Other Optic Complications
• Cataracts
• Lens Changes
• Extraocular muscle
palsy
• Glaucoma
Nephropathy
• Damage to the tiny
blood vessels within
the kidney.
• Due to
– Hyperglycemia
Nephropathy: Etiology
• h
glucose levels
– Stress kidney’s
filtration mechanism
• Blood protein leaks
into urine
• Pressure in blood
vessel of kidney h
• Kidney failure
Nephropathy: Pathophysiology
Normally
• Kidneys filter blood
• Small molecules & waste
squeeze through kidneys
 urine
• Big stuff (I.e. protein, RBC),
stay in blood where they
belong
Nephropathy: Pathophysiology
• Diabetes damages the
system
• Filters start to leak
• Protein and RBC lost
in urine
– Microalbuminuria
– Macroalbuminuria
– Proteinuria
Nephropathy: Pathophysiology
• Filters collapse
• Lose of filtering ability
– Kidney failure
– ESRF / ENRD
• Waste products build
up in blood
• Dialysis
• Kidney transplant
Nephropathy: S&S / Dx
• Proteinuria /
albuminuria
• i urine output
• Edema
• BUN & Creatinine ↑
• h BP
Nephropathy:Prevention
•
•
•
•
Control BG
Control HTN
Tx UTI
No nephrotoxic
substances
• i Na
• i Protein
Nephropathy:Management
• Tight glucose control
• Anti-hypertensives
– Calcium-channel
blockers
– Alpha blockers
– ACE inhibitor
• Dialysis
• Transplant
Neuropathy
• Damage to the Nerves due to hyperglycemia
• Most common complication
• Various Types of Neuropathies…
Neuropathy
• Sensory-Motor
Polyneuropathy
– AKA peripheral
neuropathy
– Paresthesias: primarily
lower extremities
– i deep tendon reflexes
Neuropathy
 Sensory-motor





Numb feet
i proprioception
i sensation
Unsteady gait
h risk foot injury
Neuropathy: Management
• Control serum glucose
levels
• Pain control
– Analgesics (nonnarcotic)
– Tri-cyclic
antidepressants
– Anticonvulsants
Neuropathy:
• Autonomic
neuropathy
– Autonomic NS
– Can affect almost any
system
Autonomic Neuropathy
• Cardiovascular
– Tachycardia
– Orthostatic
hypotension
– MI
Autonomic Neuropathy
• Gastro-intestinal
– Delayed gastric
emptying
– Constipation
– Diarrhea
Autonomic Neuropathy
• Urinary
– Retention
– Neurogenic bladder
Autonomic Neuropathy
• Reproductive
– Male impotence
Autonomic Neuropathy
• Adrenal Gland
– “Hypoglycemic
Unawareness”
– Adrenal Medulla
– Adrenergic symptoms
– No longer feel S&S
– Strict BG control &
frequent monitoring
Autonomic Neuropathy
• Sudomotor
neuropathy
–
–
–
–
No sweating
Anhidrosis
 dry feet
 foot ulcers
Infections
• High risk of foot
infections
– Neuropathy
• Pain sensation
– i
• Pressure sensation
– i
• Dryness
– h
• Fissures
– h
Infections
• Peripheral vascular
disease
– Circulation
• i
– WBC
• i
– Oxygen
• i
– wound healing
• Poor
– Antibiotics
• i
– Gangrene
Infections
• Immuno-compromised
– WBC + hyperglycemia =
sluggish WBC’s
Infections
• Once they occur 
difficult to treat
– Poor circulation
– Antibiotic not get
there
– Sluggish WBC’s
– Unknown wounds
Infections
• Particular concern
– Foot
infections/wounds
Boils:
 AKA: "furuncles"
 round, pus-filled
bumps on the skin
 D/T: Staphylococcus
aureus bacteria
Cellulites
• noncontagious
inflammation of the
connective tissue of
the skin,
• D/T bacterial
infection
• Treatment
– Antibiotics
– Analgesics
Infections of concern
• UTI’s
• Yeast Infections
• Periodontal disease
Infections of concern
Gangrene
• term to describe the
decay or death of an
organ or tissue
• d/t i blood supply.
Infections of concern (FYI)
• Necrotizing fasciitis
– Flesh eating disease
High risk for foot infections
•
•
•
•
•
•
Duration of diabetes
h Age
Smoking
i Peripheral pulses
i Sensation
Deformities/pressure
areas
• Hx of foot ulcers
Progression of events
•
•
•
•
Soft tissue injury 
Injury not sensed 
Infection 
Drainage, swelling,
redness 
• Gangrene 
Management of infections
• Bed rest
• Antibiotics
– Topic vs. IV
• Debridement
• Control Glucose levels
• ? Amputation
Nursing Management
• Teach foot care
– prevention
• Teach wound care
Guideline to Healthy Feet
• Wash daily
– Dry between toes
– Lubricate dry feet
• Inspect
– Mirror
– Family
– Between toes
Guideline to Healthy Feet
• Avoid activities that i
circulation
– Smoking
– Crossing legs
– Tight socks
Guideline to Healthy Feet
• Good shoes
–
–
–
–
Comfortable
Closed toe
No bare feet
New shoes
• Break in slowly
Guideline to Healthy Feet
• Prevent injuries
– Wear socks
• Cotton
• Light color
• No wrinkles
– Check inside of shoe
Guideline to Healthy Feet
• No temperature
extremes
– Check bath water
– No water bottles
– No heating pads
Guideline to Healthy Feet
• See doctor regularly
– Podiatrist
– Trim straight across
– Do not cut calluses or
corns
Guideline to Healthy Feet
• Range of Motion
Diabetics & Surgery
BS levels _____
during stress,
surgery & illness
– h
If not controlled (BG)
 osmotic diuresis
 dehydration
Diabetics & Surgery
• Risk of _________ if
give shot of NPH and
then NO surgery or
surgery delayed
– Hypoglycemia
Diabetics & Surgery
• Management
– Check BS before
surgery
– No sub-Q
– IV
Hospitalized diabetic
• Independence
• Sliding scale
• Diets
– NPO
• Still need insulin
– Clear liquids
• Most simple carbs
• Low sugar if possible
NCLEX Question
Peripheral vascular disease is most common in
patients with
A. an aneurysm.
B. viral pneumonia.
C. leukemia.
D. diabetes mellitus.
NCLEX Question
The nurse is reinforcing the importance of proper foot care to the
elderly diabetic. The woman states that they surely must have
something more important to discuss. The nurse correctly
replies:
A. “Foot care as well as any other type of hygiene is always
important.”
B. “We can skip this if you prefer.”
C. “All right, just remember that you will be more prone to foot
odor.”
D. “Diabetics can easily develop severe foot injury or infection
without knowing it.”