Clinical Topic #7 Diabetes Management Student Guide

Objectives: Student will:  Discuss pathophysiology, assessments, and nursing interventions or the prevention and treatment o diabetic ulcers!  Describe the purpose and process o blood glucose and urine "etones monitoring!  Di erentiate between various insulin preparations!  #$plain how to mi$ insulins accurately!  Describe administration o insulin with various devices!  Discuss pathophysiology, symptoms and interventions or hypoglycemia! FYI Normal Blood Glucose Levels: Kee states 60-110 mg/dL, Fundamentals 70-105 mg/dL, and Lewis 70-120 mg/dL. Students will only be tested on values wit in no!mal o! abno!mal limits "o! all o" t ese !anges. #oweve! students may want to lea!n t e Lewis level "o! ease in t!ansition to subse$uent semeste!s. Nursing Diagnosis: %mpaired Tissue %ntegrity &lood 'lucose, (is" or )nstable %n ection, (is" or *C: +ypoglycemia,+yperglycemia Discussion Questions: -! .hat puts the diabetic patient at ris" or oot ulcers/  Diabetic patients are at ris" o developing diabetic neuropathy, more speci ically, sensory neuropathy! Sensory neuropathy can cause loss o sensations li"e numbness o hands and eet and the sensations o temperature! .hen loss o sensations occur, it ma"es it harder or the patient to identi y when in0ury or in ection occurs, ma"ing it more di icult or the patient to identi y when s"in brea"down is occurring!

1! +ow would you assess the eet o a patient with diabetes/ %n a hospital setting % would chec" capillary re ill o the toes! % would loo" or any redness, swelling, blisters, or cuts on the oot! % would recommend they receive a screening using a mono ilament to asses 23*S! 4! .hat might you teach a patient to prevent diabetic oot ulcer development/  .ash 5eet daily with mild soap and warm water

dip it into the urine! : positive result can indicate lac" o insulin and diabetic acidosis! 7! #$plain how insulin preparations are di erent/ %denti y onset. and using the testing dipstic". absorbent soc"s or stoc"ings that have not been mended 7! Describe appropriate interventions to promote healing o oot ulcers! Casting may be appropriate in order to redistribute weight on the plantar sur ace o the oot! 3ther orms o wound control or oot ulcers would include: debridgement. dressings. hyperbaric o$ygen. and medication! 3ne method o monitoring a persons blood glucose level is by the use o portable blood glucose meter. you will need testing dipstic".ear clean. swelling. li estyle. which ta"es a small drop o capillary blood and assesses the amount o glucose within it! :nother way o measuring a person9s blood glucose is by the use o a Continuous 'lucose Monitoring system! This system uses needles inserted subcutaneously that assess the blood glucose level every -68 minutes! . and s"in gra ting! 8! Describe purpose and procedure or blood glucose monitoring! The monitoring o a person9s blood glucose level allows them to ma"e sel 6management decisions regarding diet. and activity patterns! The patient may receive mi$ed insulin. e$ercise. or they may receive multiple di erent doses!  (apid :cting o 3nset: -8mins o *ea": . and tender areas  )se mild oot powder or sweaty eet  (epeat s"in in ections and non6healing sores  . diabetic "etoacidosis! To monitor urine "etones. and a sterile urine cup! Collect the urine in the sterile cup. eating. vacuum6assisted closure. *at dry gently.<6=<min o Duration: 467hrs  Short :cting . blisters. pea" and duration or each! %nsulin is prepared base on the patients speci ic pattern o blood glucose levels. especially between toes  #$amine eet daily or cuts. advanced wound healing products such as (egrane$.! Describe the purpose and procedure or urine "etones monitoring! Monitoring urine "etones helps to prevent the development o conditions such as "etonuria or even worse. ultrasound.

insert it in vial : and withdraw the medication -<! #$plain the medical order or Acorrection doseB or Asliding scale!B .o 3nset: 4<6. +ours  %ntermediate :cting o 3nset:167hr o *ea": 76-< hr o Duration: -<6-.ash +ands  'ently rotate insulin bottle i cloudy  .ipe o tops o vials with alcohol sponge  %n0ect the appropriate amount o air into both vials  %nvert vial & and draw bac" the medication  (emove the needle. insulin syringes. as well as through an %@! =! .hat are the devices currently used to administer insulin/ %nsulin can currently be administered with an insulin pen. hr  2ong :cting o 3nset: -61 hr o *ea": no *ronounced *ea" o Duration: 17>hr ?! . an insulin pump.<mins o *ea": 164 +ours o Duration: 46.hat is the appropriate method or mi$ing two di erent insulin preparations/  .

or the amount o insulin in the blood is too high! Symptoms include.hat is hypoglycemia/ . not enough glucose is being produced or absorbed. sweating.hat are the causes and symptoms/ +ypoglycemia is having a low level o glucose within the blood! This can occur when the glucose within the blood is used too Cuic"ly. diDDiness. based on pre6de ined blood glucose ranges! Sliding scale insulin regimens appro$imate daily insulin reCuirements! --! . and sleepiness! -1! +ow is hypoglycemia treated/ %ngesting sugars into the body helps to treat hypoglycemia! :lso ta"ing Meglitinides daily help to lower the chance o hypoglycemia rom happening in the irst place! . con usion. nausea.The term Asliding scaleB or Acorrection doseB re ers to the progressive increase in the pre6 meal or nighttime insulin dose.

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