ANNE ARUNDEL COMMUNITY COLLEGE
80 years old Caucasian male
Admitted for Diabetes mellitus 2,wound on his toe
Significant medical history includes Coronary artery diseases with angina, Diabetics peripheral neuropathy.
PATHOPHYSIOLOGY OF DIABETICS MELLITUS 2
The combination of two primary factors causing DM2 is characterized by a defect in the secretion of insulin by the pancreatic B cells and Insulin resistance
In the case of insulin resistance, a malfunction relating to the feedback loop between insulin action and insulin secretion causes a high glucose level in the blood which causes an increase glucose production in the liver and a decrease reuptake in the muscle, liver and adipose tissue.
In the case of b-cell dysfunction, insulin secretion is reduced, limiting the body’s capacity to maintain physiologic glucose levels.
Too much glucose from the liver
High calorie diet
SIGNS AND SYMPTOMS
Polydipsia ( Increased thirst)
Polyuria (Peeing a lot)
Polyphagia (Increased hunger)
Tingling or numbness at the extremities
Wounds that take time to heal
Coronary Artery disease
Gangrene (In the extremities)
Nephropathy and chronic kidney disease
Delayed wound healing and infection
Point of care blood glucose and HgA1c testing
Evaluation and treatment by a podiatrist as needed
Evaluation and treatment by an ophthalmologist
Venous thromboembolism prophylaxis, if the patient is hospitalized
Lifestyle modifications of risk factors
Blood glucose control that includes an individualized glycemic target and blood glucose measures
Risk reduction for macrovascular (blood vessels affecting heart, brain, and peripheral vessels) and microvascular complications.
Insulin and oral med. As needed
Monitor vital signs and level of consciousness
Administer prescribed medications
Use antiembolism stockings
Get blood sample for laboratory test as ordered
Check skin turgor and mucous membranes for moisture
Monitor fluid and electrolyte imbalances
Organized activities and care for client so that it does not interfere with patient sleep time.
NURSING DIAGNOSIS #3
Risk for infection
Rationale: Patients with diabetes mellitus are prone to infection due to hyperglycemic environment that favors immune dysfunction.
NURSING DIAGNOSIS #2
Risk for unstable blood glucose level
R/T sedentary activity level, excessive intake in relation to metabolic need
NURSING DIAGNOSIS #1
Deficiency/ineffective health maintenance
R/T: dietary modifications
aeb: elevated blood glucose, overweight and development of preventable complications ( wound on the toe)
Blood glucose within normal by the end of clinical week
Decrease size of wound without infection
Client will demonstrate knowledge of :
Diabetics diet and regimen
Signs & symptoms of hypoglycemia and hyperglycemia
Identify appropriate resources
The client readiness and willingness to learn
Assess client fears and concerns about diabetics
Patient prior efforts to manage regimen
Assess blood glucose
Give prescribed medications
Clean the wound
Patient to follow diet regimen
Client to recognize the signs and symptoms of hypoglycemia.
Check the feet every day.
Moderate exercise and ambulation.
Does the patient adhere to diet modification?
If blood level falls between normal.
The HgA1C is less than 7% the goal is met.
Also, wound is healed without deterioration.
If not, re-assess.
Continue monitoring patient diet and blood glucose level, monitor wound for indication of infection
Mr. Y.S. is a patient living in assisted living facility, he has shown his willingness to comply with his diabetic diet and adhere to all that is required of him, this will aid in bringing his blood glucose level to normal range.
The nurse caring for a patient hospitalized with diabetes mellitus would look for which laboratory test result to obtain information on the patients past glucose control?
a. Prealbumin level
b. Urine ketone
c. Fasting glucose
d. Glycosylated hemoglobin level
ATI-Assessment Technology Institute, LLC. (2019). Fundamentals of Nursing (10th ed.) pp. 549
Galicia-Garcia, U., & et al Martín, C. (2020). Pathophysiology of Type 2 Diabetes Mellitus. International Journal of Molecular Sciences, 21(17), 6275. https://doi.org/10.3390/ijms21176275
Gulanick, M., and Myers, J. (2017) Nursing Care Plans, Diagnoses, Interventions, and Outcomes. (9th ed). St. Louis: Mosby. pp. 897-907
Hinkle, J., Cheever, K. (2017). Brunner and Suddarth’s textbook of medical-surgical nursing (14th ed.). Philadelphia: Lippincott, Williams, and Wilkins
Mayo clinic: Retrieved from https://mayoclinic.org/diseases-conditions/type-2-diabetes
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