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Tiffany Feliciano

NU 240 Gerontologic Nursing

Writing Assignment #4
Define Disorder
Type 2 Diabetes Mellitus: A progressive disorder in which the person has
a combination of insulin resistance and decreased secretion of insulin by
pancreatic beta cells. (Ignatavicius,Workman 2013 pg 1417)
Risk Factors (related to the older adult)
Age related changes that affect the incidence of diabetes mellitus in the
older adult include but are not limited to changes in: adiposity, sarcopenia
and physically activity. The older adult client is at risk for decreased
glucose tolerance, increased insulin resistance in the peripheral tissues
and impaired pancreatic function.
Persons with pre-existing complications with controlling blood pressure or
those with a history of cardiac problems are also at an increased risk for
developing type 2DM.
Cognitive decline can also prove to be a risk factor due to the older adults
inability to maintain a suitable diet.
Nursing Management
o Signs and Symptoms: the older adult may have and/or complain of
atypical signs and symptoms
Excessive thirst, hunger and urination
The older adult may complain of fatigue, changes in vision,
changes in weight gain (may experience gain or loss) and
complications of infection.
Some patients may also experience frequent urinary tract
infections, impotence, numbess in the extremities or
o The ADA recommends that adults age 45 years and older be
screened every 1-3 years using the FPG (fasting plasma glucose),
A1C or an oral glucose tolerance test.
o Nursing Diagnosis
Possible nursing diagnoses for the older adult include but
are not limited to:
Risk for impaired skin integrity related to impaired
Knowledge deficit: diabetes management and skills
related to lack of exposure
Altered tissue perfusion related to decreased or
interrupted arterial flow
Altered nutrition :more that body requirements related
to overeating habits or lack of regular exercise
Planning, Expected Outcomes and Goals of therapy
o Goals and planning of care should be focused on maintaining
consistent desired glucose levels, management of self-care, and
prevention of associated symptoms and complications.
o Possible patient outcomes may include but are not limited to:
The patient will follow the plan of care based on
recommendations of their healthcare providers
The client will show evidence of successful coping
Client will show knowledge of the recommended diet for
persons with type 2 Diabetes
The patient will maintain adequate circulation
The client will maintain a proper foot care regimen
Interventions and Implementation of Nursing Care
o Interventions for Diabetes management in the older adult should be
specific to the patient and may include but are not limited to:
Glucose control and monitoring
Blood Pressure control
Management of Cognitive and Physical functioning
Management of co-existing conditions and co-morbidities
Preventing falls and fractures
Lowering the incidence of polypharmacy
Monitoring vision and hearing complications
Management of diet and exercise
Assessment for and/or management of depression
o Medication
Metformin- often considered the first line of drug therapy. It
has a low risk for increased hypoglycemia however it may
cause gastrointestinal discomfort and weight loss which may
cause further complications in the older client.
Due to a high risk of hypoglycemia, Glyburide should not be
used in the older client.
Insulin therapy may also be used to control glucose levels in
the older client. Insulin therapy should be monitored carefully
in the older adult because of age related changes in the
metabolic system of older adults as well as due to possible
decline in fine motor skills and physical frailty in relation to
self-administration of insulin.
o Surgical Treatment
Whole pancreas transplantation-successful transplantation
can eliminate the need for insulin injections, glucose
monitoring and numerous dietary restrictions.
Islet Cell transplantation-*considered an experimental
procedure* this procedure eliminates the need for insulin
therapy and protects against complications of diabetes.
Surgical treatment in the older adult should be used with
caution, due to decreased healing time of diabetic patients
and older adults; there is an increased risk for post-surgical
complications such as delayed healing and increased
chance of infection.
o Non-Pharmacologic Management
Maintaining a balanced diet is essential however due to
possible lack of financial resources and unwillingness of the
older adult to make lifestyle changes, it may be difficult to
implement this change. The nurse should keep in mind that
the older patient is at an increased risk for malnutrition and
dehydration as well as lack of knowledge of adequate meal
planning and preparation.
Exercise or increasing physical activity has beneficial effects
on carbohydrate metabolism and insulin activity in the body.
Appropriate exercise activity can aide in the control of blood
glucose levels by reducing body weight, insulin resistance
and glucose intolerance.
Evaluation including Patient/Family teaching
o Patient and family education should be focused on areas that
include but are not limited to:
Diet and exercise management specific to the patients
cognitive function and physical capabilities
Teaching on self-administration of medications and insulin if
Establishing and maintaining a proper foot-care regimen
The nurse should assess and document the older adults
self-care management skills as well as the familys ability to
assist the patient in their care.
The older adult client should receive positive reinforcement
when self-care management goals are met and regular
evaluations and adjustments in goals should be made as