Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Insulin
Document related concepts
Transcript
Diabetes & selected medications Medical-surgical Nursing Chapter 64-Iggy-Pg 1300 NUR 152 Mesa Community College Learning Outcomes Describe how insulin works in the body and the effects of too little or no insulin production in the body Differentiate between type 1 and type 2 diabetes mellitus Explain the complications that can result from diabetes mellitus Use the nursing process to create nursing care plans for diabetic patients Administer the prototype drug metformin safely and effectively Differentiate between rapid, fast, intermediate, and long acting insulin Review the appropriate steps when mixing insulin Understand the nursing implications when administering insulin Review the proper techniques in blood glucose monitoring Identify diabetic patients in a state of hyperglycemia or hypoglycemia, and those at risk for these conditions Describe diabetic foot care Describe managing complications from diabetes Insulin in the body (Pg 1302) Insulin is needed to move glucose into body tissues Absence of insulin makes the body break down fat and protein for energy Absence of insulin ↑ the levels of other hormones in order to attempt to make glucose from other sources Resulting in hyperglycemia (high blood glucose levels) Polyuria Polydipsia Polyphagia Type I Diabetes (DM I) (Pg 1306) Autoimmune disorder where the beta cells are destroyed in the pancreas leading to no insulin production Genetically handed down (tissue type HLA-DR or HLA-DQ) Antibodies exist to work against beta cells and insulin Usually younger onset Type II Diabetes (DM II) (Pg 1306) *See pg 761 in Iggy as well Insulin resistance and decreased insulin production Most are obese Hereditary plays a major role Gene defects may also play a role *Metabolic Syndrome (any 3) Abdominal obesity Hyperglycemia Hypertension Hyperlipidemia Chronic Complications of Diabetes (Pg 1303-1306) Macrovascular Complications Cardiovascular Disease Cerebrovascular Disease Microvascular Eye Complications & Vision Diabetic Neuropathy Diabetic Nephropathy Male ED Cognitive Dysfunction Nursing Process & Diabetes Assessment Health History Laboratory Results Screening Ongoing Urine Assessment Tests Nursing Diagnoses Risk for injury r/t hyperglycemia Potential for impaired wound healing r/t endocrine and vascular effects of diabetes Risk for injury r/t diabetic neuropathy Acute pain r/t diabetic neuropathy Chronic Risk pain r/t diabetic neuropathy for injury r/t diabetic retinopathyreduced vision Outcomes (Goals) Performs treatment regimen as prescribed Follows recommended diet Monitors blood glucose using correct testing procedure Manages symptoms of hyper/hypoglycemia Seeks health care if blood glucose levels go outside of recommended parameters Meets recommended activity levels Uses medications as prescribed Maintains optimum weight Oral Therapy Drug (Pg 1310-1312 Chart 64-2) Therapy: DM II (Anti-diabetic, oral, Biguanide) metformin (Glucophage) Recommended Inhibits as initial therapy in type 2 diabetes mellitus hepatic glucose production Increases sensitivity of tissue to insulin Not given to people with kidney disease or elevated creatinine levels Look up in SkyScape as well! Insulin- Where does it come from and why do we need it? Pancreas - Beta cells in islets of Langerhans produce: Insulin - needed for metabolism of carbs, fats, proteins (helps move glucose into cells) Glucagon - stimulates conversion of glycogen to glucose in the liver Normal adult blood sugar - 70 to 110 mg/dL Nursing Implications Insulin Check Roll blood glucose level before giving insulin vials between hands instead of shaking them to mix suspensions Ensure Only correct storage of insulin vials use insulin syringes, calibrated in units, to measure and give insulin Ensure correct timing of insulin dose with meals Insulin order and dosages are second-checked with another nurse Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 12 Insulin (Pg 1313-1315) Rapid Acting Novolog (aspart)/Humalog (lispro) Rapid Acting-Clear Given right before a meal Onset: 15-30 minutes Peak: 1-3 ½ hrs (aspart) to 1&1/2 hours (lispro) Duration: 3-5 5 hours (aspart) hours (lispro) Short Acting Regular (Humulin R/Novolin R) Short Acting-Clear Given ½ to 1 hour before a meal Onset: Peak: 30 minutes 2 to 5 hours Duration: up to 7-8 hours Insulin (continued) Intermediate Acting Humulin N/Novolin N (isophane)-NPH (Neutral Protamine Hagedorn) Intermediate Acting Onset: Peak: 1&1/2 – 4 hours 4-14 hours Duration: Cloudy 10-24 hours Insulin (continued) Long Acting Lantus (glargine) Levemir (determir) Long Acting Long Acting Onset: Peak: 2 – 4 hrs None Duration: Never 24 hrs mixed with another insulin! Usually Onset: Peak: given twice a day 1 hours 6-8 hours Duration Never ~ 5 to 24 hours mixed with another insulin! Mixing Insulin ATI Skills Diabetes Management Step by Step Viewing Mixing Soft insulin Fundies Sliding-Scale Insulin Dosing Subcutaneous short-acting or regular insulin doses adjusted according to blood glucose test results Typically used in hospitalized diabetic patients or those on total parenteral nutrition (TPN) or enteral tube feedings Subcutaneous insulin is ordered in an amount that increases as the blood glucose increases Disadvantage: delays insulin administration until hyperglycemia occurs; results in large swings in glucose control Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 19 Sliding scale example Regular Insulin sliding scale subcutaneous with meals and at bedtime 151-200= 2 units 201-250= 4 units 251-300= 6 units 301-350= 8 units 351-400=10 units >400=Call prescriber Patient Education Blood Glucose Monitoring Target goals - Daily sugars HgbA1C (pg 1308-9) Technique Rotating sites Timing Recording Recognizing and reporting results & problems Glucose-Elevating Drugs Oral forms of concentrated glucose Buccal tablets, semisolid gel 50% dextrose in water (D50W) Glucagon Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 24 Interventions (cont): (1330-1332) Nutrition Therapy Exercise Therapy Nutrition Principles Regular Exercise Carbohydrate intake Diabetic Adjustments Dietary fat & cholesterol Safety Assessment Protein Special considerations Preventing Injury from Peripheral Neuropathy Foot Care (Chart 64-6) Preventing foot injuries Keeping blood sugars in check Foot inspection (Chart 64-5) Good fitting shoes Proper nail trimming Do not go barefoot! See your physician immediately for any break in skin Managing complications Managing Neuropathic Pain Reduced Vision Anticonvulsants Blood Glucose control Antidepressants Regular eye exams Creams Environmental management Maintain Stable Glucose Large print Bed cradle Low vision aids Good lighting Audio tools Syringe magnifiers
