Case Study #6 Metabolism, Endocrine, and Nutrition

Question 1

Describe the patho and manifestations of the two major types of DM

Answer 1

Type 1

• autoimmune destruction of beta cell
• Beta cell dysfunction
• bodys failure to produce insulin

Type 2
-result of a combination of insulin resistance and beta cell dysfunction

Question 2

Identify lab/diag tests used to diagnose and monitor DM and its complications

Answer 2

• A1C = less than 7% is considered normal, it is performed every three months. Looks at the blood sugar over a three months period
• Fasting blood glucose is performed when a patient fasts for at least 8 hour and to check his or her glucose level.
• Test for cholesterol level and levels of HDL and LDL

CBC to assess for signs of infection for elevated WBC

-Test for urine BUN and CREATININE. Normal value for BUN is 7 to 20mg/dL. Creatinine 0.5 to 1.5mg/dL

CBG

Question 3

Explain the nursing implications for pharmacological agents used to treat persons with DM

Answer 3

signs of hypoglycemic reaction (abd pain, sweating, hunger, weakness, dizziness, headache, tremor, tachycardia, anxiety

allergy

Question 4

Identify the relationship between nutrition, exercise and medications in facilitating self-management of DM

Answer 4

Medications must be given appropriately according to the amount of exercise and nutrition the person with DM is having.

Question 5

Describe the manifestations and nursing care for acute complications of diabetes

Answer 5

Diabetic Ketoacidosis
GI : N&V, abdominal pain/tenderness, fruity breath
CVS: Dehydration, hypotension/tachycardia
Resp:Kussmaul breathing
CNS:Confusion, stupor, coma
Note: Cerebral autoregulations not developed in children so at greater risk of being unable to compensate

Nursing care

• vital signs
• LOC
• fluid balance, Intake and output
• insulin therapy
• regular monitoring of CBG and ketones
• metabolic acidosis and electrolytes

Question 6

Describe the manifestations of the chronic complications of DM, appropriate prevention, and health care interventions when teaching a person wtih DM

Answer 6

Retinopathy

• cause of blindness
• maintain blood sugar levels
• proper eye exam

Nephropathy

• renal failure
• excess protein in the urine
• microalbuminuria
• increased glomerular basement membrane thickness
• proper diet and fluid

Neuropathy
-symptoms of peripheral nerve dysfunction
-demyelination of schwann cells slows nerve conducton
Vasomotor changes
•Dizziness, syncope
Bladder control issues
•Bladder infections, renal complications
GI motility issues
•Constipation, discomfort, nausea, vomiting after meals (postprandial), bloating
•Diarrhea also possible (d/t poorly controlled type 1 DM)
Sexual dysfunction
Erectile dysfunction
-Proper skin and foot care

Question 7

Macro complications and preventions

Answer 7

CAD (cardiovascular disease)
Annual screening of ECG, total cholesterol, LDL, HDL, triglycerides
Nutritional therapy
Exercise
Weight loss
Lipid-lowering medications
ACE inhibitors, Beta-blockers, or aspirin

CVA (cerebral vascular accident)
4 x more likely than non diabetic
risks increase with hypertension, dyslipidemia, smoker, overweight

PVD (peripheral vascular disease)
10 x non diabetics
intermittent claudication
cramping pain in lower extremities from inadequate blood supply to contracting muscles (relieved with rest while standing)
can progress to resting claudication (relief with sitting at edge of bed)
can lead to foot/leg wounds, gangrene