- 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)