1、1Diabetes Mellitus 2Teaching objectives grasp the definition and types of diabetes mellitus realize etiology and pathogenesis realize diagnosis and classification grasp the clinical manifestation for the patient with diabetes mellitus be aware of the main lab examination realize the treatment for th
2、e patient with diabetes mellitus3Introduction There are more and more people suffer from diabetes with the development of society, population aging and changes of life style. 4Diabetes mellitus is a group of metabolic disorders characterized by chronic hyperglycemia which results from the defects of
3、 insulin secretion or function, or both.5Long-standing diabetes may lead to multisystem damage such as eye, kidney, nerve, heart, blood vessels and so on.6Etiology Etiology and pathology are complex, and still unknown. But it is a syndrome results from compound etiological factor and has relation to
4、 inheritance, autoimmune and environment. 7Factors associated with diabetes include obesity, aging, and ethnic group. 8ClassificationnType 1 diabetesuStage 1: genetics emotivityuStage 2: start autoimmuneuStage 3: immunology abnormality 9uStage 4: progressive dysfunction of beta cellsuStage 5: clinic
5、al diabetesuStage 6: beta cells of the clients who have longtime diabetes are damaged thoroughly, blood insulin level is very low10nType 2 diabetesugenetics emotivityuhyperinsulinism and (or) insulin resistanceuimpaired glucose tolerance (IGT)uclinical diabetes 11nOther types uinclude beta cell gene
6、tic defects, endocrinopathies, and drug or chemical-induced diabetesugestational diabetes mellitus12Clinical manifestation nMetabolic disorders syndrome: polyuria, polydipsia, polyphagia and weight loss13nAcute complications of diabetes: DKA, hyperosmolar nonketotic diabetic coma, infection14DKA u e
7、vocation factors surgery, stress, infection, deficiency of insulin dosage, pregnancy, delivery, anesthesia, or illness may trigger DKA15uClinical featuresClassic symptoms of hyperglycemia (polyuria, polyphagia, polydipsia) precede DKA. Other symptoms: nausea, vomiting, abdominal pain, headache, weak
8、ness, fatigue, hyperpnea16uLab test Laboratory values will reveal blood glucose from 300 to 600 mg/dl(16.7-33.3mmol/l), and metabolic acidosis. Urine will be positive for glucose and ketones.17hyperosmolar nonketotic diabetic comauevocation factors include illness or other stressor such as infection
9、, cerebrovascular events, or some drugs.18uClinical features lethargy, illusion, disorientation, seizure and coma.19uLab test blood glucose is higher than 33.3 mmol/l, usually 33.3-66.6 mmol/l and serum osmolality 350 mmol/l20infectionuSkin infection, septicaemia, pulmonary tuberculosis,infection of
10、 urinary system21nChronic complications of diabetes: cardiovascular diseases, nephropathy, diabetic neuropathy, retinopathy, diabetic foot infection22Cardiovascular diseases pain, paresthesia of lower extremeties and intermittent claudication heart failure, arrhythmia, cardiogenic shock,and sudden d
11、eath23Nephropathy nephrosclerosis edema, proteinuria, hypertension24diabetic neuropathy numbness, pain and paresthesia of extremeties, muscular atrophy25retinopathy : microangiopathydiabetic foot infection: gangrenous 262728Lab test nurine glucose nblood glucose nIGT29Treatment nDiet maintain as nea
12、r-normal blood glucose level as possible, achieve optimal serum lipid levels, provide adequate energy.30nActivity: aerobic exercisenOral glucose-lowering agents: sulfonylurea, biguanides, glucosidasenInsulin therapy 31Insulin Therapy noticeadminister insulin as ordered, inject insulin on time with c
13、orrect type and precise dosagetime, position and method of injectionside effects of insulin therapy: hypoglycemia, insulin allergy, subcutaneous fat atrophy or proliferation32nTransplantation of pancreas and islet nTreatment for gestational diabetes nTreatment for DKA : intravenous infusion, insulin
14、 therapy, keep balance of electrolyte and acid-base, prevent and manage complicationsnHyperosmolar nonketotic diabetic coma33Nursing process nAssessment uSubjective datauObjective data34 Nursing diagnosis 1: Deficient Knowledge: Diabetes, medical regimen, diet, exercise, self-care management skills
15、(insulin injection, SMBG) related to new diagnosis or changes in treatment Nursing diagnosis 2: Imbalanced Nutrition: Less than body requirements related to imbalance between insulin, diet, and activity35 Nursing diagnosis 3: risk for infection related to hyperglycemia, fat metabolism disorder Nursing diagnosis 4: potential complications hypoglycemia Nursing diagnosis 5: potential complications DKA, hyperosmolar coma36
