Diabetes pathophysiology complications nursing care
Mrs.S, a housewife, 50 years old is admitted in I.C.U. with Diabetes Mellitus. She is a known case of Diabetes on irregular treatment. On admission her blood sugar level is 295.
(a) Discuss the pathophysiology of diabetes Mellitus.
(b) List down the complications of Diabetes Mellitus.
(c) Discuss in detail the nursing care of Mrs.S. applying nursing process.
Pathophysiology
Insulin from the pancreas. is an anabolic or storage hormone
On eating food, insulin secretion increases and moves glucose from the blood into muscle,liver, and fat cells.
In those cells, insulin:
• Transports and metabolizes glucose for energy
• Stimulates storage of glucose in the liver and muscle (in the form of glycogen)
• Signals the liver to stop the release of glucose
• Enhances storage of dietary fat in adipose tissue
• Accelerates transport of amino acids (derived from dietary protein) into cells
• Insulin also inhibits the breakdown of stored glucose, protein,and fat.
During fasting periods (between meals and overnight), the pancreas continuously releases a small amount of insulin (basal insulin);
Glucagon from alpha cells of pancreas is released whenblood glucose levels decrease and stimulate the liver to releasestored glucose.
Insulin and glucagon together maintain a constant level of glucose in the blood by stimulating the release of glucose from the liver Initially,
Liver produces glucose through the breakdown of glycogen (glycogenolysis).
After 8 to 12 hours without food liver forms glucose from the breakdown of noncarbohydrate substances, including amino acids (gluconeogenesis).
Complications of Diabetes Mellitus
Examples of chronic complications
Diabetic cardiomyopathy
Diabetic nephropathy
Diabetic neuropathy
Diabetic retinopathy
Diabetic encephalopathy[
Macrovascular disease leads to cardiovascular disease, to which accelerated atherosclerosis is a contributor:
Coronary artery disease,
Diabetic myonecrosis
Peripheral vascular disease
Diabetic foot
Skin ulcers (diabetic foot ulcers) and infection and, in serious cases, necrosis and gangrene.
Blindness
A female infertility, such as reflected by delayed puberty and menarche, menstrual irregularities (especially oligomenorrhoea), mild hyperandrogenism, polycystic ovarian syndrome, fewer live born children and possibly earlier menopause.
Restrictive lung defect
Lipohypertrophy may be caused by insulin therapy.
Vitamin D insufficiency
Diabetic Coma
DKA - Diabetic Ketoacidosis
Hyperosmolar nonketotic state (HNS) - an acute complication sharing many symptoms with DKA, but an entirely different origin and different treatment.
NURSING CARE
Complications must not be neglected in elderly patients.
Hypoglycemia is especially dangerous because it may go undetected.
Look for Dehydration
Assess for long-term complications,
Especially eye and foot problems, is important.
Look vascular disease, surgery
The patient is assessed for hypoglycemia and hyperglycemia with frequent blood glucose monitoring
Monitor for DKA or HHNS.
Examine for Skin breakdown, especially at pressure points. The skin is assessed for dryness, cracks, skin breakdown, and redness.
Ask about symptoms of neuropathy, such as tingling and pain or numbness of the feet.
Deep tendon reflexes are assessed.
Look for hypertension, increased lipids, and smoking,
Eye examination (including dilation of the pupil).
The patient’s diet is planned with considering the patient’s primary health problem in addition to lifestyle, cultural background, activity level, and food preferences. Alterations made for the primary health problem
about diabetes self-care skills
The patient’s nutritional intake is monitored carefully along with blood glucose,
Asses urine ketones, and daily weight.
Blood glucose records are assessed for patterns of hypoglycemia and hyperglycemia at the same time of day, and findings are reported to the physician for alteration in insulin orders.
Feet are cleaned with warm water and soap. The feet are dried thoroughly, especially between the toes, and lotion is applied to the entire foot except between thetoes.
The heels are elevated off the bed with a pillow placed under the lower legs and the heels resting over the edge of
the pillow.
Attend to Dermal ulcers
Insulin is administered as prescribed. Insulin prescribed is modified
as needed
Treatment is given for hypoglycemia (with oral glucose) or hyperglycemia (with supplemental regular insulin no more often than every 3 to 4 hours)
Impart knowledge
