12. Caring for Older Adults During Illness - diabetes

Question 1

Insulin

Answer 1

NORMALLY,

• insulin from pancreas guides glucose into cells for energy and storage
• insulin needs to be present to open the door for sugar to enter the cell

Question 2

Diabetes Mellitus

Answer 2

Type 1

• beta cells of pancreas that produce insulin are destroyed by an autoimmune process
• before 30 yr
• 5-10% of diabetic pts

Type 2
-decrease sensitivity to insulin = type 2
or
-from decreased amount of insulin production
-90-95% of diabetic pts
-occurs more in 30+ yrs

Question 3

Risk Factors

Answer 3

Ethnicity

• white more prone to Type 1
• indig, hispan, african american prone to Type 2

Age

High BP

First-degree relative with DM

Obesity

Low birthweight

High cholesterol

Question 4

Complications of DM

Answer 4

Acute complications:

• hypoglycemia
• hyperglycemia
• glyosuria: sugar in urine
• DKA: occurs when the body starts breaking down fat at a rate that is much too fast. The liver processes the fat into a fuel called ketones, which causes the blood to become acidic.

Chronic complications:

• macro and microvascular disease
• neuropathic disease affecting sensory-motor and autonomic nerves

more complications:

• atherosclerosis
• risk for amputation (dt risk of infection rt elevated glucose which encourages bacterial growth)
• decreased peristalsis - nausea, vomiting, constipation, bloating, heartburn

Question 5

Assessment:

Answer 5

Assess ability to perform diabetes self care

Assess for signs of DKA

Question 6

Assessment:

Answer 6

Assess ability to perform diabetes self-care

Assess for signs of DKA

Monitor lab results for electrolyte imbalance and treat ASAP

Evaluate pt’s social support situation that influence treatment

Evaluate daily schedule (work, meals, exercise)

Question 7

Interventions

Answer 7

2 Pharmacological

1. Antihyperglycemic medication
   - PO
   - insulin

• to increase insulin secretion
• to enhance insulin sensitivity by decreasing insulin resistance

Rapid acting:

• onset 10-15 min
• peak 60-90 min
• take right before meal

Short acting:

• onset 30 min
• peak 2-3 hr
• take 30 min before meal
• ex Humulin R

Intermediate acting:

• onset 1-3 hr
• peak 5-8 hr
• take at bedtime or 2x/day
• ex Humulin N

Long acting:

• onset 90 min
• peak none
• take 1-2x/day

Non-pharm:

Teach about diet

Teach about blood sugar monitoring:
-hypoglycemia- juice, glucose tab, eat snacks

Teach about foot/skincare

Monitor for risk of infection and reduced healing

Question 8

HEART FAILURE

Answer 8

• a syndrome that occurs when the heart can’t pump enough blood to meet the body’s metabolic needs
• often follows CAD, esp after a myocardial infarction dt heart damage from ischemia

Age-related changes:

• impaired contractile properties of the heart
• impaired filling of the heart= lower CO
• increased workload on the heart
• eventual resistance to filing of the heart

Risk Factor:
-diabetes. Causes more sugar in the blood = irritates the blood vessels = heart failure

Clinical Manifestation:

• low CO= dizziness, confusion, fatigue, cool extremities
• increased pulmonary venus pressure= cough and SOB
• increased systemic venous pressure = peripheral edema and weight gain
• dysrhythmia and dyspnea

Question 9

Stages of Heart Failure

Answer 9

Class I: Asymptomatic
-cardiac disease but no limitations noted

Class II: Mild heart failure

• some limitation of PA, comfortable at rest
• PA = fatigue, palpitations, dyspnea, angina pain

Class III: Moderate heart failure

• limitation during PA, comfortable at rest
• walking and stairs brings on symptoms mentioned above
• rest required

Class IV: Severe heart failure

• permanent bedrest
• cannot do PA without severe symptoms
• some symptoms even at rest
• chronic SOB

Question 10

Assessment & Diagnostic Methods

Answer 10

Auscultate lung for fluid sound and heart for S3

Echocardiogram to see how much CO

ECG

Stress test

Question 11

Interventions

Answer 11

Medications are to be titrated to minimize side effects:

• diuretic to decrease fluid overload
• vasodilators to increase efficient movement of blood oxygen and nutrients
• contractility agents to increase heart muscle use

Assess need for O2 therapy, TED stockings

Monitor for worsening symptoms:
-malaise/discomfort
-syncope/faint
-chest pain
dyspnea
-orthopnea at night
-rapid weight gain >2kg in 3 days

Measure intake and output

Teach low sodium diet and fluid restriction

Monitor response to activity and encourage to avoid energy-consuming activities