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DIABETES MELLITUS (1)

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1. IMAM TRI SUTRISNO
2. RIFANTIKA PUSPITASARI
3. NOVIE PRAWITANINGSIH
4. APRILIYA PUSPITA SARI
5. MIFTACHUL JANNAH
6. ENGGAR RATNA KUSUMA
7. RAFIKA ROSYDA
8. FITRIANI
• Diabetes Mellitus is metabolic disorder that
characterized by hyperglycemia (elevated blood
glucose level) (Munden, 2007).
• Diabetes Mellitus is abnormal metabolism
requiring lifelong treatment with diet, exercise
and medication (Carpenito, 2008).
•
•
•
•
A parent or sibling with diabetes
Obesity
Age older than 45 years old.
History of diabetes during pregnancy (gestational
diabetes) or delivering a neonate weighing more
than 4,1 kg.
• High blood pressure
• High triglyceride levels
• High cholesterol levels (Munden, 2007).
The classic symptoms of diabetes
mellitus are : polyuria, polydipsia,
polyphagia, and loss of weight.
 may develop rapidly (weeks or
months) in type 1 diabetes,
 while they usually develop much
more slowly and may be absent in
type 2 diabetes
Table Criteria For The Diagnosis Of Diabetes
HbA1C ≥ 6.5% OR
FPG(Fasting Plasma Glucose) ≥ 126 mg/dl OR
In a patient with classic symptoms of hyperglycemia
or hyperglycemic crisis, a random plasma glucose ≥
200 mg/dl OR
2-hours plasma glucose ≥ 200 mg/dl during an
OGTT.
MANAGEMENT
•
•
•
-
The principles of food management for people
with diabetes :
Limit intake of foods high in fat, salt and sugar
Eat regular meals with carbohydrate making up
approximately 50% of meals
Diet :
Carbohydrates - 60%
Fats - 30%
Protein - 12-20%
Try to increase fruit and vegetable intake
• Insulin therapy:
1. Rapid-acting insulin
2. Long-acting insulin
3. Intermediate options
Examples include: Insulin lispro (Humalog),
Insulin aspart (Novolog), Insulin glargine
(Lantus), Insulin detemir (Levemir), Insulin
isophane (Humulin N, Novolin N).
PREVENTIONS OF COMPLICATIONS
•
•
•
•
•
•
•
•
Control the value of blood glucose
Diet
Pressure control
Enough of rest
Exercise
Decreasing salt’s consumption
Stop smoking
Make schedule to consult with doctor
1.Chronic
2.Acute
a. Cardiovascular disease
b. Cerebrovascular disease
c. Retinopathy (vision) problems
d. Diabetic neuropathy
e. Diabetic nephropathy
a. Diabetic ketoacidosis
b. Hyperglycemic-hyperosmolarnonketotic syndrome
c. Hypoglycemia from too much
insulin or too little glucose
1. Activity / Rest
weakness, fatigue, difficulty moving / walking, muscle cramps,
decreased muscle tone, decreased muscle strength.
2. Circulation
ulcers on the legs, a long healing process, numbness in the
extremities, skin hot, dry and reddish.
3. Ego integrity
depend on others, anxiety, sensitive stimuli.
4. Elimination
changes in the pattern of urination (polyuria), nocturia, dilute
urine, pale dry, poliurine.
5. Food / fluid
loss of appetite, nausea / vomiting, do not follow
the diet, weight loss, dry skin / scaly, ugly turgor.
6. Pain / comfort
pain in the ulcer wound, face grimacing with
palpitations, looks very carefully.
7. Security
dry skin, itching, skin ulcers, fever, diaphoresis,
damaged skin, lesion / ulceration
8. Counseling / learning
family risk factors diabetes, heart disease, stroke,
hypertension, long healing. The use of drugs such
as steroids, diuretics (thiazides): diantin and
phenobarbital (may increase blood glucose levels).
• Fluid volume deficit related to osmotic diuresis, nausea,
vomiting.
• Imbalanced nutrition less than body requarements related to
decreased oral input: anorexia, nausea, vomitting.
• Risk of infection related to inadequate peripheral defense,
changes in circulation, high blood sugar levels, invasive
procedures and skin damage.
• Risk for impaired skin integrity related to Diabetic process,
altered pigmentation from microangiopathy, skin changes
related to the aging process, pressure on skin surfaces, bed
rest, immobility, intermittent claudication, alterations in tissue
perfusion.
• Disturbance of daily activity related to weakness and fatigue.
• Risk of injury related to disturbance of vision.
1). Fluid Volume Deficit related to osmotic diuresis, nausea, vomiting.
Expected outcomes : Patients showed an improvement in fluid balance, spending
adequate urine (normal range), vital signs stable, clear peripheral pulse
pressure, good skin turgor, capillary refill well and mucous membranes moist or
wet.
Intervention / Implementation:
1. Monitor vital signs, note the presence of orthostatic blood pressure.
R: Hypovolemia can be manifested by hypotension and tachycardia.
2. Assess breathing and breath patterns.
R: The lungs secrete carbonic acid is produced through respiration
compensated respiratory alkalosis, the state of ketoacidosis.
3. Assess temperature, color and moisture.
R: Fever, chills, and diaphoresis is common in the infection process. Fever with
skin redness, dry, maybe a picture of dehydration.
4. Assess peripheral pulses, capillary refill, skin turgor and mucous membranes.
R: Is an indicator of the level of dehydration or adequate circulating volume.
5. Monitor intake and output. Record the urine specific gravity.
R: Provide the estimated need for fluid replacement, renal function and the
effectiveness of a given therapy.
6. Measure body weight every day.
R: Provide the best results of the assessment of the status of ongoing fluid and
further in giving replacement fluids.
7. Collaboration fluid therapy as indicated
R: Type and amount of fluid depends on the degree of dehydration and
individual patient response.
2). Imbalanced Nutrition, Less Than Body Requirements related to decreased oral
input: anorexia, nausea, vomitting.
Goal : weight can be increased with normal laboratory values ​and no signs of
malnutrition.
Expected outcomes : Patients are able to express an understanding of substance
abuse, decrease the amount of intake (diet on nutritional status).
Demonstrate behaviors, lifestyle changes to improve and maintain a proper
weight.
Intervention / Implementation :
1. Measure body weight as indicated.
R: Knowing eating adequate income.
2. Determine the diet program and diet of patients compared with food that can
be spent on the patient.
R: Identify deviations from the requirements.
3. Auscultation of bowel sounds, record the presence of abdominal pain /
abdominal bloating, nausea, vomiting, keep fasting as indicated.
R: Influence of intervention options.
4. Observation of the signs of hypoglycemia, such as changes in level of
consciousness, cold / humid, rapid pulse, hunger and dizziness.
R: Potentially life-threatening, which must be multiplied and handled
appropriately.
5. Collaboration in the delivery of insulin, blood sugar tests and diet.
R: It is useful to control blood sugar levels.
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