Transcript What are the FACES of Diabetes?

What are the FACES of Diabetes?
Alteration in Metabolism
Cost/Fiscal Burden
• How much money is it
estimated that Diabetes
costs this nation
annually?
• What does that mean to
you as a nurse?
Prevalence
• How many people are affected with
diabetes?
• How many people are newly
diagnosed with diabetes annually?
• What percentage of the people with
diabetes have Type 1 vs. Type 2?
• What does that make you think?
Prevalence
• In 1985 how many
people/children under the age of
20 were diagnosed with type 2
diabetes?
• In 2009 how many
people/children under the age of
20 were diagnosed with type 2
diabetes.
Morbidity and Mortality
• Diabetes is the ______ leading cause of
death in the US.
• What leading illnesses does diabetes
contribute to?
• What does that make you think????
What is the FACE of Diabetes?
What is ???????
• Insulin
• Glucose
• What is the primary source of energy for
your body? What else can it use?
• What is the primary source of energy for
your brain? What else can it use?
• What is hypo/hyper glycemia?
What happens to our body
when?
• Hypoglycemic
• Hyperglycemic
What happens to our bodies
when we are hyperglycemic?
Blood Glucose
>110
Insulin
Resistance
Increased
Free Fatty
Acid
Oxidative
Stress
Decreased
Insulin
Oxidative
Stress
Nitric Oxide
Activation of
activator protein -l
Nitric oxide
Tissue factor
Plasminogen
Activator
Prostaccyclin
Inflammation
Thrombosis
Nitric Oxide
Endothelin-1
Angiotensin ll
Vasoconstriction
hypertension
Vascular smooth
muscle cell growth
Angiotensin ll
Release of chemokines
Release of cytokines
Expression of cellular
adhesion molecules
Hyper coagulation
Platelet Activation
Decreased Fibrinolysis
So what disease states are you
at risk for???
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•
•
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•
MI
DVT
PE
Stroke
AAA
Retinopathy
What happens to our bodies
when we are hyperglycemic?
Metabolic
Stress Response
Stress hormones
and peptides
Increased Glucose
Decreased Insulin
Increased Glucose
Decreased Insulin
Immune
Dysfunction
Infection
Dissemination
Increase in:
Ketones
Free Fatty Acids
Lactate
Cellular Injury
Inflammation
Tissue Damage
Altered Tissue Healing
Acidosis
Thrombosis
Global Infarction
Ischemia
Reactive 02
Species
Increase
Transcription
Factors
Leads to
Secondary
Meadiators
DID YOU KNOW ANY
BLOOD SUGAR GREATER
THEN ________ STARTS
THESE PROSES?
WHAT DOES IT DO TO YOUR
IMMUNE SYSTEM?
Case Study
Mrs. Sugar is a 57 year old obese female patient, her height is 5’
3” that has been seeing the same PCP for 15 years. She is in
for her annual check up. She has a history of HTN,
bronchitis, COPD, sedentary lifestyle, non compliance with
diet and exercise recommendations. Mrs. Sugar had her lab
work done prior to coming to the PCP and these were the
results:
• -Complete Blood Count
VS
• WBW-13.5
Na-140
B/P 150/67
• RBC-5.5
K- 4.0
HR 77
• HGB- 12.0
Glucose-205
RR 18
• HCT-32
HbgA1c-8
Temp. 98.6
• Weight-210
Bun/Creat- 18/1.4
Assessment Data
• What other assessment data will
you obtain and why?
– Subjective
– Objective
Optimal Levels of Blood
Sugars/Glucose
• Preprandial-110 mg/dl
• Postprandial-180 mg/dl
What is her diagnosis?????
What type of medication should the
PCP start Mrs. Sugar on and
why?
How will you monitor if the
medication is effective or not?
What nursing diagnosis would be
appropriate at this time?
What teaching must be done at this time?
What goals would you set with the
patient?
Mrs. Sugar has come in every month for
3 months and has been doing well.
Mrs. Sugar returns to the office 10 months from her
original diagnosis b/c she is not feeling well. She
said she has had a cold, runny nose, non productive
cough, post nasal drip, and has had a low grade
fever of 100.9.
You assess Mrs. Sugar VS: B/P 95/69, HR 106, RR 15,
O2 sat RA 91%, Temp. 101. Heart tones clear,
pulses palp, Lungs diminished in that bases with
crackles and patient appears SOB, fruity breath,
mocous membranes are dry, patient has not c/o GI
upset and is able to urinate w/o difficulty but is
going all the time in large amounts. Denies pain at
this time. She is sent to the ER.
You are the ER nurse you assess the
patient and all the data is the same as
the office nurse.
What assessment would you do next?
Mrs. Sugar is admitted to the hospital
for What????
What is the most sever complication of
DKA?
What do you anticipate your orders to
be and why?
What are some nursing diagnosis at this
time?
Mrs. Sugar is very upset and states b/c
she has never had to take insulin
before, she just takes the pills. How
will you respond to her?
Prior to being discharged you review
Mrs. Sugar’s Blood Sugar Diary. You
note there were many times during the
day that her glucose was above 200.
You show this to the endocrinologist
and they wrote orders that the patient
will go home on insulin, along with the
oral hypoglycemic agents.
What education do you anticipate
needing to review with Mrs. Sugar?
Mrs. Sugar was seen 1 week after
discharge and dong well. She
maintained her preprandial blood
sugar below ??? and post prandial
below ??? She has also lost 20lbs.
6 months later you are reviewing Mrs.
Sugars labs and note that her renal
and hepatic function are abnormal.
What can this be due to?
B/C Mrs. Sugar was so compliant with
her medication and diet what can we
recommend her to use for her
diabetes?
Insulin Pump
Why are they better for patients?
What type of insulin can be used with
AN INSULIN PUMP?
New Case Study
• Mandy is a 18 year old girl who has had
type 1 diabetes since she was 2 years old.
She has been to the office/then hospitalized
several time this year with elevated blood
sugars >500 and ketones in her urine.
• Mandy has been having trouble at home
following her parents rules and has been
sneaking out at night and drinking alcohol.
Her parents said she has a boyfriend and he
encourages this behavior as well.
• What does alcohol do to your blood
sugar?
• What medical diagnosis was she
admitted for several times this year?
• ‘What are the potential complications
of this diagnosis?
• Mandy has presented to the ER the 3rd time
this month in DKA. She was unresponsive
when she arrived. She was admitted to the
ICU on an insulin drip. Her blood sugar is
stabilized and she wants to sign out AMA,
which she has done the 3 prior admissions.
• Mandy is now yelling at you and telling you
she wants to get the hell out of here and get
her the paperwork. She is crying.
• As the nurse how do you handle that
situation?
• What do you say to Mandy?
• Who do you need to notify?
What nursing diagnosis may
apply???
• You over hear Mandy talking with her
mother and she is still crying. Mandy
says “He thinks I am strange bc I have
to watch what I eat and give myself
shots. I hate it. I love him so much and
I don’t want to live if I cant have
him.”
• What do you think about that
statement and what do you do?
• Can you let Mandy just leave?
• Do you call her mother or boyfriend
and tell them to convince her to stay?
• What do you think may be going on
and why?