WEEK SEVEN Flashcards
Type 1 diabetes:
10-15% of diabetic population No insulin produced NON preventable Young children and young adults Highest in Scandinavians Lowest in tribal communities
Risk factors of type 1?
Genetic susceptibility
Environmental factors
Acquired factors such as autoimmune reactions
Idiopathic
Nursing assessment and intervention?
The nature of his diabetes Insulin self-management Monitoring his BGL Knowledge about Insulin Consideration of other medications Recognition of symptoms Current diet Exercise he is undertaking Knowledge and practice in inspecting feet Current stressors
Pros of diabetes education?
Increases knowledge and understanding
Increases individuals self-determination
Increases ability to self-manage condition
Increases ability to make psychological adjustments
Hypoglycaemic education?
HYPOGLYCAEMIA BGL < 4mmols Nervous or Irritable Hungry Becoming tired and withdrawn Headache Weak or dizzy Shaky Skin becomes clammy, pale and sweaty Confused Extremely drowsy/ disorientated/ unconscious – severe reaction
Hyperglycaemic education?
HYPERGLYCAEMIA BGL >15 mmols Dry mouth, fruity breath Passing lots of urine Needing to drink lots or feeling thirsty Feeling hungry Vomiting Weight loss
School expectations
Diabetes management health plan
- Diabetes Management & Emergency Response Plan by PMH
- BGL above 15 mmol, no ketones, if feels well may play sports
- BGL above 15 mmol, has ketones and feels unwell must tell his teacher
- To play sports must ensure they do extra BGL testing before, during and after sport
- Pt expected to have a hypo kit with him and it must be easily accessible
- Pt expected to have special considerations during examination times
- May also need a special bus card that allows him to eat on the bus
Pt education for adminstering insulin
Encourage to have family member present
Explain that you will explain each step of the process
Teach how to undertake BGL reading and record it
Demonstrate use of insulin injection technique
Has patient demonstrate this technique
Discuss injection sites and rotation to prevent lipohypertrophy
Use patient literature
Discuss disposal of sharps and storage of insulin
Discuss understanding of hyper and hypo glycaemia symptoms and treatment
Discuss sick day rules
Advantages of continuous insulin infusion?
Eliminates individual insulin injections
More accurate than injections
Insulin pumps often improve HbA1c
Fewer large swings in your blood glucose levels
Management is easy
Allows flexibility about when and what they eat
Improves quality of life
Insulin pumps allow patients to exercise without having to eat large amounts of carbohydrate
Disadvantages of continous insulin infusion?
Can cause weight gain Can cause diabetic ketoacidosis (DKA) Can be expensive Can be bothersome Can require a hospital stay to be trained
Screening for gestational diabetes?
BGL elevated OGTT Fasting: > 95 mg/dL 1 hours >180 mg/dL 2 hours >155 mg/dL 3 hours >140 mg/dL
Treatment for gestational diabetes
BGL:1 is higher than normal (change diet)
BGL: >1 Gestational Diabetes
Treatment and management of insulin resistance?
Medication: Metformin Actos and Rosiglitazone Prednisone Insulin Diuretics, Asprin, Atorvastatin
Alternative treatments:
Omega-3 fatty acids
Fenugreek
Chromium supplements, ginseng,andacupuncture.
Self Management: Reduce Weight by 10% Exercise 30 minutes most days Increase fibre in diet Quit smoking Limiting alcohol intake (Frey, R. 2006)
physcosocial barriers of?
Sense of restriction with freedom
Were fearful, in denial, and felt depressed
Had high levels of stress, were angry and felt irritable
Needed to communicate with other similar people
Needed to talk about emotional barriers and ways to increase willpower and motivation
Felt their illnesses or injuries prevented them from doing regular exercise
Considered they had little time to manage their diabetes
Were concerned about costs of medications, supplies and healthy food.
Had challenges in obtaining necessary supplies
Barriers to optimal care?
Health Care System
Self-Management Education
Time to See Provider Is Limited
Patient Education Is Undervalued by the Health Care System
Low Level of Health Literacy
Inadequate Education
The Lack of Evidence or Knowledge to Support Self-Management Education
The Lack of Research Skills Among Practicing Nurses
The Lack of Coordination Between Researchers and Clinicians
