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Kristen A Geroulis RN Chamberlain College of Nursing NR 305 Health Assessment Professor Jennifer Thyes April 17 2011
Introduction Summary of Relevant Evidence Health Assessment Stragies Screening Guidelines Prevention Strategies Conclusion
INTRODUCTION 3 .
2011). kidney disease. 2011). stroke. metabolic syndrome of gradual onset charcterized by insufficent body tissue response to insulin and impaired pancreatic production of insulin (Strayer & Schub. blindness. Diabetes is a chronic. Diabetes is a leading cause of heart disease.gov/diabetes/pubs/pdf/ndfs _2007. pregancy complications. high blood pressure. amputations. multisystem. Diabetes was the 7th leading cause of death in America in 2006 (Molinaro.pdf) 4 .cdc. and nervous system disease (http://www.
SUMMARY OF RELEVANT EVIDENCE 5 .
6 . 2011).Signs and Symptoms Polyuria (increased urination) Polydipsia (increased thirst) Polyphagia (increase hunger) Unexplained changes in weight Fatigue Recurrant infections Prolonged wound healing Vision changes (Strayer & Schub.
Risk Factors Family History Previous Gestational diabetes (became diabetic while preganant) Abnormal fasting blood glucose Abnormal glucose tolerace Obesity Sedentary Lifestyle Increased Age Hypertension Polycystic Ovarian Syndrome Dyslipidemia (Strayer & Schub. 7 . 2011).
Viewpoints of Disease Management Keep blood glucose between 70 110 mg/dl Following a balanced diet ± Balance foods that raise sugar with foods that don t affect blood sugar Regular exercise ± 30 minutes of moderate aerobic exercise (swimming or walking) most days of week Taking prescibed medications (Moshang. 2005) 8 .
Reduce weight to body mass index (BMI) below 25 (ideally). 2010). (Whittaker. Reduce cholesterol level with diet and statin therapy.Viewpoints of Disease Management Stop smoking with appropriate support. Reduce blood pressure to below 140/80mmHg medication may be required. 9 .
Current Literature on Nursing Interventions Work in collaboration with community groups to ± raise awareness of the seriousness of diabetes ± risk factors and strategies for preventing diabetes in a culturally sensitive and appropriate manner Public Health Nurse may advocate for a national social marketing campaign to support and promote awareness of risk factors associated with diabetes. identifying those at high risk and those who are undiagnosed (Price. 2008). ways of reducing the risks. 10 .
HEALTH ASSESSMENT STRATEGIES 11 .
Expected Normal Findings Fasting plasma glucose <100 (Strayer & Schub. 12 . 2011).
13 . 2011).Expected Abnormal Findings Fasting plasma glucose of >126 (Strayer & Schub. 2011). 2011).5% (Strayer & Schub. Abnormal levels of acetone or glucose in urine (Strayer & Schub. Glycosylated hemoglobin (HbA1C) level increased >6.
itchy skin (Moshang.Description of Assessment Techniques Complete history and physical Family History Any abnormal blood glucose levels High cholestrol level Blurred vision Yeast infection Urinary Tract Infection Dry. 2005). 14 .
Screening Guidelines 15 .
(Hoffman-Goetz. All diabetic individuals should have A1C measured every 3 months.0% or lower for most individuals and 6. People with additional risk factors should be screened earlier or more frequently A1C and glycemic goals are 7.0% or lower when it can be safely achieved. & Thomson. 16 .2009).Current Guidelines for Screening Population Asymptomatic individuals over 40 years old should be screened every 3 years. Donelle.
and interdisciplinary team approach to diabetes management to encourage patient education and self-care and share responsibility for patients achieving glucose goals del Prato. 2005).Implementation of guidelines into nursing practice Aim for good glycaemic control.5%* within 6 months of diagnosis Implement a multi. Felton. & Zinman. Munro. Zimmet. 17 . Nesto. including the treatment of insulin resistance Treat patients intensively so as to achieve target HbA1c < 6. defined as HbA1c < 6.5%* Monitor HbA1c every 3 months in addition to regular glucose selfmonitoring Refer all newly diagnosed patients to a unit specialising in diabetes care where possible Address the underlying pathophysiology.
PREVENTION STRATEGIES 18 .
Non-Drug measures to Reduce Incidence Eat a balanced diet Exercise Stress Reduction Educated individuals about risk factors of diabetes Encourage individuals to have a body mass index below 25 19 .
If normal and the patient is not at high risk. Review interventions for weight loss. Include regular use of low dose aspirin (if there are not contraindications) for cardiovascular disease prevention. Annually: Obtain fasting lipid profile (every two years if patient has low-risk lipid values). Perform comprehensive foot exam to check circulation. Counsel on smoking cessation and alcohol use. or changes in shape. lipids. as appropriate. and physical activity as indicated. or other mood disorder. Review self-management skills. Assess for coping. Perform urine test for albumin-to-creatinine ratio in patients with type 1 diabetes more than five years and in all patients with type 2 diabetes.gov/publications/Publ icationDetail. » http://ndep. lesions. and calculate BMI.aspx?PubId=108#page9 20 .Measures to deal with high-risk patients Measure weight. Administer influenza vaccination. Obtain A1C in patients whose therapy has changed or who are not meeting glycemic goals (twice a year if at goal with stable glycemia). and identify high-risk feet. Inspect feet for lesions or abnormalities if one or more high-risk foot conditions are present. the eye care specialist may advise an exam every two to three years. Review need for other preventive care or treatment. Review self-monitoring glucose record. mouth infections. Obtain serum creatinine to estimate glomerular filtration rate and stage the level of chronic kidney disease. dietary needs. blood pressure. progress toward behavior change goals. Review/adjust medications to control glucose. Refer for dental/oral exam at least once a year to prevent periodontal disease. blood pressure. sensation. and loss of teeth. Refer for dilated eye exam by an ophthalmologist or optometrist to detect retinal and other eye complications.nih. depression.
CONCLUSION 21 .
Importance of disease Estimated economic costs of undiagnosed diabetes in 2007 is $18 billion ($2864 per person). 2009). 2009) 22 . 2009) Costs associated with Type 2 diabetes are $159.4 billion.7 billion and indirect costs of $53. including medical costs of $10.. Approximately $14. (Dall et al.8 billion..5 billion and indirect costs of $4.. including medical costs of $105. (Dall et al.9 billion (8.6%) of the economic burden of diagnosed diabetes is associated with Type 1 diabetes. including medical costs of $11 billion and indirect costs of $7 billion (Zhang et al.5 billion.
2005) 23 .Need for Evidence in Managing and Preventing Disease Diabetes can lead into: ± Macrovascular complications Coronary Artery Disease (CAD) Peripherial Artery Disease (PVD) ± Microvascular complications Retinopathy Nephropathy Neuropathy (Moshang.
Implications for Nursing Knowing risk factors for diabetes Diabetes education for patients Encourage healthy balanced diet Encourage 30 minutes of aerobic exercise daily Patients trust nurses. therefore they will listen when the nurse gives information Collaborate with other healthcare providers to give patinet the best care. 24 .
International Journal of Clinical Practice.. Dall. Donelle. T. Type 2. L. The economic costs of undiagnosed diabetes.. Y. V. 25(10). 23. Zimmet. & Thomson. R. 12(2). A. Diabetes. B. T. MLO: Medical Laboratory Observer.. Martin. 12(2). Retrieved from EBSCOhost. N. Moore.... Zhang. (2005). Nursing made Incredibily Easy!.. J. E. 25. Retrieved from EBSCOhost. Zhang. W. K. D. Nursing Standard. Informatics for Health & Social Care. R. Retrieved from EBSCOhost. JOCEPS: The Journal of Chi Eta Phi Sorority. Mann. Population Health Management. Felton. Nesto. S.. Nursing Standard. W. L.. Whittaker.. 8-15. Retrieved from EBSCOhost. Retrieved from EBSCOhost. Retrieved from EBSCOhost. & .. Public health nursing and diabetes prevention. 103-110. 1345-1355.. Munro. Retrieved from EBSCOhost.. Seifert. del Prato. Quick. & Zinman. Y. 43(2). Zhang. S. Chen.... (2008). Type 2 diabetes: growing by leaps and bounds. 20-34.. 25 . (2009).. 95-101. this article is based on NS481 Hill J (2009) reducing the risk of complications associated with diabetes.References Dall. J. 59(11).. Martin. & Schub.. Price. J. Molinaro.. P. (2009). 91-99.. 53(1). (2011). S. 49-55. (2005). (2009). Mann.. R. 34(2). Distinguishing the economic costs associated with type 1 and type 2 diabetes. Diabetes Mellitus. S. Hoffman-Goetz. Retrieved from EBSCOhost. (2011). Y. Population Health Management.. Strayer. T. 59. Moshang. M. 20-23.. (2010).. Improving glucose management: ten steps to get more patients with type 2 diabetes to glycaemic goal. Clinical guidelines about diabetes and the accuracy of peer information in an unmoderated online health forum for retired persons. Diabetes cases on the rise: current diagnosis guidelines and research efforts for a cure. & . Quick.
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