Transcript NRS 220 Diabetes Exemplar

Denise Coffey MSN, RN
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American Diabetes
Association:www.diabetes.org
Nearly 26 million Americans have diabetes and
an estimated 79 million U.S. adults have
prediabetes‚ according to new estimates from
the Centers for Disease Control and Prevention
(CDC).
The National Diabetes Fact Sheet for 2011 says
that diabetes affects 8.3 percent of all Americans
and 11.3 percent among those aged 20 and
older. An estimated 7 million Americans with
diabetes do not know they have the disease!!
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Insulin: what is it’s function??
Glucose: what is it’s function??
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Type I –which is?
Type 2 –which is?
Gestational Diabetes (GDM)
Other specific conditions resulting in
hyperglycemia
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Hyperglycemia: what would you expect to
see?
Lab work
Where do we want to see our patient’s lab
values at?
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Hypoglycemia: what are some signs and
symptoms?
What are you going to do as the RN assigned
to a patient experiencing hypoglycemia?
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Microvascular: you tell me!
Macrovascular: you tell me!
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3 P’s: polyuria, polydipsia, polyphagia
Describe other assessment findings you
would need to be on the look out for.
Blood Glucose
>110
Insulin
Resistance
Increased
Free Fatty
Acid
Oxidative
Stress
Decreased
Insulin
Oxidative
Stress
Nitric Oxide
Endothelin-1
Angiotensin ll
Vasoconstriction
hypertension
Vascular smooth
muscle cell growth
Nitric Oxide
Activation of
activator protein -l
Nitric oxide
Tissue factor
Plasminogen
Activator
Prostaccyclin
Inflammation
Thrombosis
Angiotensin ll
Release of chemokines
Release of cytokines
Expression of cellular
adhesion molecules
Hyper coagulation
Platelet Activation
Decreased Fibrinolysis
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
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Diet –what teaching would you provide to
your patient?
Exercise
PO medications- what teaching would you
provide to our patient
Insulin therapies
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Insulin pumps
Pancreas transplant
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Patient education:
What education would you need to make
sure you patient receives?