1、.Diabetes Mellitus .Teaching 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 mellitus.Introduction There are more and more people suffer from diabetes with the development of society,population aging and changes of life style.Diabetes mellitus is a group of metabolic disorders characterized by chronic hyperglycemia which results from the defects of in
3、sulin secretion or function,or both.Long-standing diabetes may lead to multisystem damage such as eye,kidney,nerve,heart,blood vessels and so on.Etiology Etiology and pathology are complex,and still unknown.But it is a syndrome results from compound etiological factor and has relation to inheritance
4、,autoimmune and environment.Factors associated with diabetes include obesity,aging,and ethnic group.ClassificationnType 1 diabetesuStage 1:genetics emotivityuStage 2:start autoimmuneuStage 3:immunology abnormality.uStage 4:progressive dysfunction of beta cellsuStage 5:clinical diabetesuStage 6:beta
5、cells of the clients who have longtime diabetes are damaged thoroughly,blood insulin level is very low.nType 2 diabetesugenetics emotivityuhyperinsulinism and(or)insulin resistanceuimpaired glucose tolerance(IGT)uclinical diabetes.nOther types uinclude beta cell genetic defects,endocrinopathies,and
6、drug or chemical-induced diabetesugestational diabetes mellitus.Clinical manifestation nMetabolic disorders syndrome:polyuria,polydipsia,polyphagia and weight loss.nAcute complications of diabetes:DKA,hyperosmolar nonketotic diabetic coma,infection.DKA u evocation factors surgery,stress,infection,de
7、ficiency of insulin dosage,pregnancy,delivery,anesthesia,or illness may trigger DKA.uClinical featuresClassic symptoms of hyperglycemia(polyuria,polyphagia,polydipsia)precede DKA.Other symptoms:nausea,vomiting,abdominal pain,headache,weakness,fatigue,hyperpnea.uLab test Laboratory values will reveal
8、 blood glucose from 300 to 600 mg/dl(16.7-33.3mmol/l),and metabolic acidosis.Urine will be positive for glucose and ketones.hyperosmolar nonketotic diabetic comauevocation factors include illness or other stressor such as infection,cerebrovascular events,or some drugs.uClinical features lethargy,ill
9、usion,disorientation,seizure and coma.uLab test blood glucose is higher than 33.3 mmol/l,usually 33.3-66.6 mmol/l and serum osmolality 350 mmol/l.infectionuSkin infection,septicaemia,pulmonary tuberculosis,infection of urinary system.nChronic complications of diabetes:cardiovascular diseases,nephrop
10、athy,diabetic neuropathy,retinopathy,diabetic foot infection.Cardiovascular diseases pain,paresthesia of lower extremeties and intermittent claudication heart failure,arrhythmia,cardiogenic shock,and sudden death.Nephropathy nephrosclerosis edema,proteinuria,hypertension.diabetic neuropathy numbness
11、,pain and paresthesia of extremeties,muscular atrophy.retinopathy:microangiopathydiabetic foot infection:gangrenous .Lab test nurine glucose nblood glucose nIGT.Treatment nDiet maintain as near-normal blood glucose level as possible,achieve optimal serum lipid levels,provide adequate energy.nActivit
12、y:aerobic exercisenOral glucose-lowering agents:sulfonylurea,biguanides,glucosidasenInsulin therapy.Insulin Therapy noticeadminister insulin as ordered,inject insulin on time with correct type and precise dosagetime,position and method of injectionside effects of insulin therapy:hypoglycemia,insulin
13、 allergy,subcutaneous fat atrophy or proliferation.nTransplantation of pancreas and islet nTreatment for gestational diabetes nTreatment for DKA:intravenous infusion,insulin therapy,keep balance of electrolyte and acid-base,prevent and manage complicationsnHyperosmolar nonketotic diabetic coma.Nursi
14、ng process nAssessment uSubjective datauObjective data.Nursing diagnosis 1:Deficient Knowledge:Diabetes,medical regimen,diet,exercise,self-care management skills(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 activity.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 coma.
