Diabetes Mellitus PLAN

Transcription

1 Diabetes Mellitus PLAN Move through DM case study using algorithms and Iggy charts, teach about DM mgmt., Medications & insulin therapy using IHS handout and other resources, Discuss complications of DM. Highlight sensory concerns

2 Office Hours Prof. Winstanley R-344 and Prof. McCabe R-344 Monday 3/24 7:30 8 am Question & Answer, so bring your questions Monday 3/24 8:00 8:50 Finish Exam 2 review First and second exams will be available for you to review by appointment

3 Medication Study Preparation Use the ATI pharmacology ATI Medication templates Daily Med Davis Drug Guide Handouts from class and evolve Reliable Websites Other reliable references PLAY Medication Jeopardy in Evolve You can learn the meds

4 Creating a Focused Review in ATI Go to My results. Select practice assessment or exam. Select item from list. Select Create on right side. Scroll down and select Create Focused Review. The review will always be in ATI for you in My Results. Check all of the boxes to create a PDF of the focused review to make it more portable or selct to access it online at you r convenience.

5 Clarification of terms DOSE RATE CONCENTRATION PCA BASAL = CONTINUOUS PCA = DEMAND BOLUS Total medication delivered Total volume delivered

6 NURSING PROCESS ASSESSMENT DATA FOR NURSING DIAGNOSIS NURSING DIAGNOSIS COLLABORATIVE PROBLEMS EXPECTED OUTCOMES WITH INDICATORS NURSING INTERVENTIONS SCIENTIFIC RATIONALE FOR NURSING INTERVENTIONS REALISTIC EVALUATION Effectiveness of Nursing Interventions Attainment of Expected Outcomes

7 Chronic Disease Management Readiness for Enhanced Self Health Management Readiness for Enhanced Nutrition Risk for Imbalanced Nutrition Ineffective Health Maintenance Ineffective Self Health Management Risk for Unstable Blood Glucose level Sedentary Lifestyle Noncompliance

8 Readiness for Enhanced Self Health Management The person will describe strategies to address progression or complications of condition should they arise. The dynamic nature of chronic conditions necessitates knowledge of how to balance one s life to keep symptoms under control as much as possible. NIC: Behavior modification, Mutual goal setting, Teaching, Decision-making support, Health system guidance, & Anticipatory guidance. Carpenito-Moyet, 863.

9 Including: Lifestyle modifications Adherance/Compliance Coping Emotional Support Financial Support Patient-family centered care Partnering with patients and families to improve their health Avoid/delay TOD

10 The Good News for Smokers:

11 POLYPHARMACY Sometimes, especially with DM & HTN Small amounts of multiple meds work better than larger amounts of one med How does this affect the patient? More pills Higher cost More to remember timing, indications, Combination medications The POLYPILL is almost here!

12 RHABDOMYOLYSIS: Risk for Impaired kidney function Why do we worry? article/ htm

13 Diabetes Euglycemia Hyperglycemia Diabetic Ketoacidosis HHS: Hyperglycemic-Hyperosmolar state Hypoglycemia

14 Pathophysiology pp Starts with an absence of insulin Can also be insulin resistance Hyperglycemia P P P (ketones) Polyuria, polydipsia, polyphagia

15 Pathophysiology pp Dehydration H H H H H H Hemoconcentration, Hypovolemia, Hyperviscosity, Hypoperfusion, Hypoxia, Hypercoaguable [Hyperinsulinemia in Type 2] Lactic acidosis

16 Insulin Physiology

17 Pathophysiology pp Metabolic acidosis ph, HCO3, Compensatory Respiratory Alkalosis PaCO2 Kussmauls respirations Fruity breath Looks like? Pink or blue?

18 Pathophysiology pp POTASSIUM - an essential electrolyte Excreted in the urine remember P? serum levels BUT ph causes electrolye shifts Potassium moves from the cells into the bloodstream serum levels SO YOU HAVE TO the K+ Before any treatment

19 Factors influencing the Potassium level: Hydration level Severity of Acidosis Response to treatment

20 What does the patient look like?????

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24 Generally, the injurious effects of hyperglycemia are separated into macrovascular complications (coronary artery disease, peripheral arterial disease, and stroke) and microvascular complications (diabetic nephropathy, neuropathy, and retinopathy).

25 AMPUTATION Dialysis

26 Resources etes/index.cfm?module=resourcesprovide r

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31 Euglycemia: Algorithm for Type II DM 31

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33 Review the remainder of the case study The pace will be quick!

34 NURSING PROCESS ASSESSMENT DATA FOR NURSING DIAGNOSIS NURSING DIAGNOSIS COLLABORATIVE PROBLEMS EXPECTED OUTCOMES WITH INDICATORS NURSING INTERVENTIONS SCIENTIFIC RATIONALE FOR NURSING INTERVENTIONS REALISTIC EVALUATION Effectiveness of Nursing Interventions Attainment of Expected Outcomes

35 Chronic Disease Management Readiness for Enhanced Self Health Management Readiness for Enhanced Nutrition Risk for Imbalanced Nutrition Ineffective Health Maintenance Ineffective Self Health Management Risk for Unstable Blood Glucose level Sedentary Lifestyle Noncompliance

36 Readiness for Enhanced Self Health Management The person will describe strategies to address progression or complications of condition should they arise. The dynamic nature of chronic conditions necessitates knowledge of how to balance one s life to keep symptoms under control as much as possible. NIC: Behavior modification, Mutual goal setting, Teaching, Decision-making support, Health system guidance, & Anticipatory guidance. Carpenito-Moyet, 863.

37 Complete Course Evaluations Dear Students, Below is the link to an important end of the course survey. The purpose of the survey is to aid in improving the School of Nursing program. Your responses are extremely important. This survey is 7-10 questions and should only take you 1 to 2 minutes to complete. Please also complete the clinical site evaluation in the MySCCC Group pages. Thank you so much for your time. Happy Holidays to all and Good luck on your final exams. NUR Sincerely, Cheryl Shaffer PhD, PNP, ANP College Associate Dean PS: You can find this link in your .

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