HYPERTENSION & DIABETES MELLITUS DIAGNOSTIC TEST

 Physical Examination
OUTLINE:  Complete Blood Count
 Chest X-ray
I. What is Hypertension?  ECG
II. Types LIFESTYLE MODIFICATION
III. Etiology  Weight reduction
IV. Risk Factors  Dash diet
V. Diagnostic Test  Dietary sodium reduction
VI. Management  Reduce alcohol
VII. Nursing Management  Exercise
VIII. Diabetes Mellitus  Stress management
IX. Etiology PHARMACOLOGIC THERAPY
X. Types  Diuretics
XI. Assessment  Beta Blockers
 Alpha Blockers
XII. Diagnostic Tests  Vasodilators
XIII. Medical Management  ACE Inhibitors
XIV. Nursing Management  Calcum Channel Blockers
XV. Nursing Responsibilities NURSING MANAGEMENT
1. Proper history collection should be done which includes
WHAT IS HYPERTENSION? family history

 Also known as high blood pressure, is a long term

medical condition in which the blood vessels have 2. Dietary habits should be assessed
persistently raised pressure. Blood is carried from the 3. Identify the medical history such as diabetes, CAD, renal
heart to all parts of the body in the vessels. Each time the disease
heart beats, it pumps blood into the vessels. 4. Instruct the patient to avoid smoking and alcholism
TYPES OF HYPERTENSION 5. Auscultate heart rate and palpate peripheral pulses
 Prehypertension 6. Identify the use of the medication such as contraceptives,
Systolic: 120-139mmHg steroids, NSAIDs
Diastolic:80-89mmHg 7. Monitor vital signs frequently
 Hypertension Stage 1 8. Provide diet which is low in sodium and rich with fruits and
Systolic: 140-159mmHg vegetables
Diastolic: 90-99mmHg 9. Monitor blood cholesterol level frequently
 Hypertension Stage 2 DIABETES MELLITUS
Systolic: ≥ 160mmHg  A chronic disorder of carbohydrate, protein and fat
Diastolic: ≥100mmHg metabolism resulting from an imbalance between insulin
 Pregnancy Induced Hypertension availability and insulin need.
ETIOLOGY ETIOLOGY
 Elevation in Blood Pressure without an identified cause  Absolute insulin deficiency
 Neurological Disorders  Impaired release of insulin
 Congenital Narrowing of the Aorta  Inadequate or defective receptor site
 Sleep Apnea  Production of inactive insulin
 Medications TYPES
 Renal Disease  Type 1: Insulin dependent diabetes mellitus
 Cirrhosis Liver  Type 2: Non-insulin dependent diabetes mellitus
 Endocrine Disorders  Gestational Diabetes Mellitus: a condition in which a
RISK FACTORS hormone made by the placenta prevents the body from
 Age (hypertension starts at 50 y.o.) using insulin effectively. Glucose builds up in the blood
 Family History instead of being absorbed by the cells.
 Alcohol, Smoking and Diabetes Mellitus TYPE 1 TYPE 2
 Obesity  Is caused by destruction  Is a condition of fasting
 Sedentary Life Style of the beta cells in the hyperglycemia that
 Excessive dietary intake of Sodium islets of Langerhans of occurs despite the
 Stress the pancreas availability of
 Gender endogenous insulin
 Combined genetic,  Heredity is responsible
immunologic, and for up to 90% of cases
possibly environmental of type 2 diabetes
ABONADO, ALONZO, LAHURAN, MARCOJOS BSN-2D 1
 (eg. viral) factors are
thought to contribute to METFORMIN
beta cell destruction  Oral Hypoglycemic Agents: BIGUANIDES
 Only 5% to 10% of  It affects approximately  Indication: Lower serum glucose levels by inhibiting
people with diabetes 90% to 95% of people hepatic glucose production and increase sensitivity or
have type 1 diabetes with the disease; 80% peripheral tissue to insulin
for obese clients and  Adverse Reactions: Hypoglycemia, Abdominal
20% for non obese discomfort, Diarrhea
 Control: Difficult with  Control: Often only
wide glycemic swings dietary restrictions and MEDICATIONS
exercise required
 Medication: Insulin  Medication: Maybe  Routes of Administration:all insulins are given
required by all none, oral parenterally. Only regular insulin is given by both
hypoglycemics or insulin subcutaneous and IV routes
 Starts when 30 y.o.  Starts after 30 y.o.  Sites of Injection: the rate of absorption and peaj of
action of insulin differs according to the site
ASSESSMENT  Mixing insulins: regular insulin may be mixed with all
 3 P’s: Polyphagia, Polyuria, Polydipsia types of insulin except glargine and determir; it may be
 Hyperglycemia injected immediately after mixing or stored for future use.
 Weight loss, malaise and fatigue - NPH insulin and PZI insulin may be mixed only with
 Blurred vision regular insulin
 Glycosuria - always withdraw regular insulin first to avoid
 Slow wound healing contaminating the regular insulin wtih intermediate-acting
 Vaginal infections insulin
 Weakness and paresthesias NURSING MANAGEMENT
 Signs of inadequate feet circulation  Administer insulin or oral hypoglycemic agents as
DIAGNOSTIC TESTS ordered
 Fasting Blood Sugar  Provide special diet as ordered
 Oral Glucose Tolerance Test  Monitor urine sugar and acetone
 Casual Plasma Glucose concentration equal or greater  Perform finger sticks (CGB/HGT) to monitor glucose level
than 200mg/dl with symptoms of Diabetes mellitus as ordered
(Polydipsia, Polyphagia, Polyuria)  Provide meticulous skin care and prevent injury
 Postprandial glucose level  Maintain Intake and Output
 Glycosylated hemoglobin  Weight daily
MEDICAL MANAGEMENT  Provide emotional support
 Pharmacotherapy Insulin  Observe for chronic complications and plan care
- people with type 1 must have insulin; those with accordingly
type 2 are usually able to control glucose levels with  Provide client teaching and discharge planning
an oral hypoglycemic medication instructions
 Sources of Insulin NURSING RESPONSIBILITIES
- derived from animal (pork pancreas) or synthesized  Oral hypoglycemics
in the laboratory  Blood glucose monitoring
 Types/Insulin Preparations  General care
- insulins are available in rapid-acting, short-acting,  Foot care
intermediate-acting, and long-acting preparations  exercise

ABONADO, ALONZO, LAHURAN, MARCOJOS BSN-2D 2