Lincoln Memorial University Department of Nursing Nursing 124/125 Spring Semester 2005

Transcription

1 Lincoln Memorial University Department of Nursing Nursing 124/125 Spring Semester 2005 LESSON PLAN Metabolic/Endocrine Function: Diabetes Mellitus DATES & TIMES: See Class Schedule OBJECTIVES: Upon completion of this unit, the student will be able to demonstrate, in the clinical/campus laboratory setting, in individual and group conferences and on written material the ability to: 1. Define key terms as listed in assigned readings. 2. Using Roy s Adaptation Model (RAM), recognize human adaptive responses to behavior or stimuli that affect endocrine function as it relates to Diabetes Mellitus (DM). 3. Discuss the focal stimulus associated with Type I and Type II diabetes mellitus. 4. Identify important behaviors and common stimuli in the recognition of adaptive versus ineffective human responses related to DM. 5. Utilize the RAM nursing process for delivery of basic nursing care to adults experiencing adaptive versus ineffective responses associated with DM. 6. Use the RAM in the development of individualized plans of care for adults with DM. 7. Discuss adaptation techniques utilized by human persons with diabetes mellitus to maintain appropriate balance of this disease process to include diet, exercise, lifestyle changes, foot care, insulin, and oral anti-diabetic medications. 8. Explain how each of the following diagnostic tests are performed, pre- and post-test nursing responsibilities, and normal values. Discuss the implications and significance of normal and abnormal results: a. Capillary blood glucose testing b. Fasting Blood Sugar (FBS) c. Glycosylated Hgb A1C (HgA1C) d. Oral glucose tolerance test (OGTT) e. Urine sugar and ketones f. Two-hour post-prandial glucose tolerance test 9. Differentiate between Type I and Type II DM related to etiology, symptoms, diagnosis, and treatment. 10. List and compare the four groups of insulin preparations (immediate-acting, rapid acting, intermediate-acting, and long-acting). Discuss trade names, onset, peak and duration. Compare actions, side effects, and nursing implications associated with each insulin group. 15. List and compare oral anti diabetic agents, actions, side effects, and nursing implications. 16. Explain the basic principles of ADA exchange lists and plan a 3-day calorie-restricted menu for an adult with DM. 17. Identify teaching/learning strategies when providing care to adult human persons by developing a teaching plan to include insulin and its administration, recognition of signs and symptoms of hyper/hypoglycemia and actions to take, blood and urine glucose testing, skin and foot care, diet, exercise, lifestyle changes, and pre-and postoperative care. 19. Explain recent trends in diabetic management and research including insulin pumps, pens, and injectors. TOPICAL OUTLINE

2 I. Overview and Assessment of the Endocrine System II. III. IV. Processes Associated with Endocrine Function and DM A. Type I Diabetes B. Type II Diabetes Common Diagnostic Tests A. Capillary blood glucose testing B. Fasting Blood Sugar (FBS) C. Glycosylated Hgb A1C (HgA1C) D. Oral glucose tolerance test (OGTT) E. Urine sugar and ketones F. Two-hour post-prandial glucose tolerance test RAM Nursing Process and Endocrine Function A. Assessment of stimuli and behavior related to endocrine function B. Nursing diagnoses related to endocrine function C. Goals related to endocrine function D. Interventions for the adult experiencing ineffective responses of endocrine function E. Evaluation of interventions for adaptive responses V. Teaching Adults Experiencing DM and Promoting Adaptive Responses A. Diet B. Exercise C. Lifestyle Changes D. Foot Care E. Blood Glucose Monitoring F. Urine Testing G. Hyperglycemia and hypoglycemia H. Medication Administration i. Oral antidiabetic medications ii. Insulin I. Sick Day Rules VI. Recent Trends in Diabetes Management A. Alternate methods of insulin delivery 1. Insulin Pens 2. Insulin Pumps 3. Jet Injectors

3 REQUIRED READINGS: Silvestri, L. A. (2002). Saunders comprehensive review for NCLEX-RN. (2 nd ed.). Philadelphia: W.B. Saunders Company. Smeltzer, S. G., & Bare, B. G. (2004). Brunner and Suddarth s textbook of medical surgical nursing. (10 th ed.). Philadelphia: Lippincott, Williams & Wilkins. Chapter 41. Taylor, C., Lillis, C. & Lemone, P. (2005). Fundamentals of nursing: The art and science of nursing care. (5 th ed.). Philadelphia: Lippincott. REFERENCE TEXTS: Ackley, B. & Ladwig, G. (2004). Nursing diagnosis handabok: A guide to planning care. (6 th ed.). St. Louis: Mosby. Dirckx, J. (2001). Stedman s concise medical dictionary for the health professions. (4 th ed.). Philadelphia: Lippincott, Williams & Wilkins. Fischbach, F. (2002). Nurses quick reference to common laboratory and diagnostic tests. (3 rd ed.). Philadelphia: Lippincott Williams & Wilkins. Karch, A. M. (2005) Lippincott s nursing drug guide. Philadelphia: Lippincott, Williams & Wilkins. Smeltzer, S. G. & Bare, B. G. (2004). Handbook for Brunner & Suddarth s textbook of medical-surgical nursing. (10 th ed.). Philadelphia: Lippincott, Williams & Wilkins. Smeltzer, S. G. & Bare, B. G. (2004). Study guide to accompany Brunner and Suddarth s textbook of medical-surgical nursing. (10 th ed.). Philadelphia: Lippincott, Williams & Wilkins. Taylor, C., Lillis, C., & LeMone, P. (2005). Study guide to accompany fundamentals of nursing: The art and science of nursing care (5 th ed.). Philadelphia: Lippincott, Williams & Wilkins.

4 - 4 - AUDIOVISUAL MATERIALS: EV2 A Close Watch - Intensified Management of Type II Diabetes * Diabetes and Its Complication DRUG LIST: Avandia (Nosiglitazone Mallate) Diabeta Diabinese Dymelor D 50 W Glucagon Hydrochloride Glucotrol Glucovance Insulins (All the different types) Humulin R Humulin N Humulin L Humulin U Lispro Humalog Humulin 70/30 Humulin 75/25 Metformin (Glucophage) Micronase Orinase CLNICAL OBJECTIVES: 1. Review common diagnostic tests for the adult with Diabetes Mellitus (DM). 2. Assess assigned adults for compromised or ineffective responses to endocrine function: DM 3. Develop a teaching/learning plan for insulin self-administration. 4. Develop a teaching plan for a diabetic adult and the dietary changes necessary to promote adaptation. 5. Utilizing the Roy Adaptation Model nursing process, develop a plan of care for an adult with compromised or ineffective responses to endocrine function: DM. 6. Accurately administer subcutaneous and IV insulin. 7. Accurately administer oral hypoglycemic agents. 8. Develop a teaching/learning plan that includes foot and skin care, signs and symptoms of hypo and hyperglycemia, blood and urine glucose testing for the adult with DM. 9. Plan a three-day menu using a calorie prescription and appropriate exchange list.

5 - 5 - LINCOLN MEMORIAL UNIVERSITY DEPARTMENT OF NURSING NURSING 125 DRUG STUDY GUIDE ENDOCRINE: DIABETES MELLITUS Answer the following questions: 1. Explain how sliding scale insulin is determined for each patient. What type of insulin is used to administer sliding scale insulin. 2. A patient is taking a combination of regular insulin and intermediate insulin. What instructions should be included? 3. Your patient is receiving an IV of normal saline with regular insulin. What needs to be monitored closely? 4. Effects of oral anti-diabetes drugs may be prolonged or enhanced by what drugs? 5. The nurse administers regular insulin 10 units S.C. to a patient with Type I diabetes around 7:00 a.m. How soon should the patient plan to eat breakfast after the insulin injection?