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  • Open-Discussion
  • Provide Materials
  • Enroll in Diabetes Education Program
  • Refer to Diabetes Educator
  • Demonstrate Insulin Therapy:
  • Return demo upon initial teaching and follow-up
  • Check injection sites for signs of rotating sites/infections
  • Review administration procedures such as technique
  • Review blood GLU history
  • Can the patient state the signs/sx of hyper/hypoglycemia?
  • Can the patient state what to do when:
  • Blood GLU is below 70 or above 240
  • Ketones are present in urine
  • Does the patient have working glucometer or supplies?
  • Can the patient demonstrate how to use glucometer? syringe? draw up insulin?
  • Drug Therapy
  • Insulin
  • Oral Agents
  • Nutrition Therapy
  • Maintain blood GLU to prevent hyper/hypoglycemia
  • Exercise
  • Regular, consistent physical routine
  • Blood GLU Monitoring
  • Pancreas Transplantation
  • usually performed together with kidney transplant
  • lifelong immunosuppression
  • Diabetic Ketoacidosis (DKA)-high blood GLU, ketones present, vomiting, severe fluid and electrolyte depletion
  • Hyperosmolar Hyperglycemic syndrome-high blood GLU over 600, but NO ketones, dehydration
  • Treatment:
  • Monitor blood GLU and presence of ketones in urine closely
  • Admin IV fluids to correct dehydration and fluid/electrolyte imbalance
  • Assess renal and cardiopulmonary status
  • Monitor LOC
  • Inform pt that stress induces hyperglycemia
  • Continue regular meals
  • Increase noncaloric fluids (broths, water, diet gelatin)
  • Check blood GLU every 4 hours
  • Check ketones if blood GLU greater than 240
  • Take insulin/oral agents (OA) as prescribed
  • DISCONTINUE METFORMIN if procedure required contrast dye
  • WAIT until 48 hours post-procedure AND verify serum creatinine levels are normal then continue Metformin as prescribed
  • UNCONSCIOUS PT:
  • HYPOGLYCEMIA: Observe pt for sweating, tachycardia, tremors. MONITOR GLU CLOSELY!
  • Reduce onset of severe complications:
  • Blood GLU monitoring
  • Proper nutrition to prevent hyper/hypoglycemia
  • Good hygiene for infection control
  • Pain control
  • Neuropathy medications: Duloxetine, Gabapentin, Pregabalin
  • Assess pt for signs of depression
  • Refer patient to resource materials such as online sites (ADA)

Lifelong Treatment

Therapeutic Communication

Treatment of Severe Complications

Patient Knowledge

(Lewis, Dirksen, Heitkemper, Bucher, 2011, p. 1223, 1229-1235)

(Lewis, Dirksen, Heitkemper, Bucher, 2011, p. 1245)

(Lewis, Dirksen, Heitkemper, Bucher, 2011, p. 1240)

Diabetes Mellitus

Nursing Responsibilities of the Surgical Patient

Prevention

References

Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Camera, I. M. (2011) Medical-surgical nursing: Assessment and management of clinical problems (8th ed.). St. Louis, MO: Mosby.

(Lewis, Dirksen, Heitkemper, Bucher, 2011, p. 1240-1242))

Diabetes Mellitus Concept Map

(Lewis, Dirksen, Heitkemper, Bucher, 2011, p. 1237-1239)

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