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Patients are also educated on dietary changes. This is the main goal of diabetes treatment — normalization of blood glucose levels to reduce the development of vascular and neuropathic complications. In approaching the elderly patient, a thoughtful individualized approach, consistent with the heterogeneity of the aging process, should be used. Nursing School Test Banks Chapter 64: Care of Patients with Diabetes Mellitus Chapter 64: Care of Patients with Diabetes Mellitus Ignatavicius: Medical-Surgical Nursing, 8th Edition MULTIPLE CHOICE 1.A nurse is teaching a client with diabetes mellitus who asks, “Why is it necessary to maintain my blood glu-cose levels no lower than about 60 mg/dL?” ?” How should the nurse re Should the patient A dietician is also brought on board, their role being to emphasize on the maintenance of comfortable body weight and a minimum of 30 minutes exercise. © 2020 by the American Diabetes Association. 2. The goals of preconception care are to 1) integrate the patient into the management of her diabetes, 2) achieve the lowest A1C test results possible without excessive hypoglycemia, 3) assure effective contraception until stable and acceptable glycemia is achieved, and 4) identify, evaluate, and treat long-term diabetic complications such as retinopathy, nephropathy, neuropathy, hypertension, and CAD. ADA evidence grading system for clinical practice recommendations, Criteria for testing for diabetes in asymptomatic adult individuals, Summary of recommendations for adults with diabetes mellitus, Correlation between A1C level and mean plasma glucose levels (27), Definitions of abnormalities in albumin excretion. Women contemplating pregnancy need to be seen frequently by a multidisciplinary team experienced in the management of diabetes before and during pregnancy. Most recent review/revision, October 2002. Chapter 67 Care of Patients with Diabetes Mellitus 61 Terms. Altered biomechanics (in the presence of neuropathy). High blood pressure is an established risk factor for the development of macular edema and is associated with the presence of proliferative diabetic retinopathy (PDR). An Organic Method For a Natural Acne Solution – Apple Cider Vinegar, Emergency contact numbers such Patients must, therefore, attend appointments as directed by their health providers to keep the blood sugar levels under control. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. There is no threshhold for A1C values above which the risk begins or below which it disappears. Diabetes is treated by insulin in type 1, and exercise and diet or in combination with insulin in type 2. Start studying Care of Patients with Diabetes Mellitus - MedSurg. What Is Manuka Honey and Why Is It Special? Examinations will be required more frequently if retinopathy is progressing. Prospective Diabetes Study. Successful control of comorbidities, such as hypertension and hyperlipidemia, is also important. Availability and involvement of expert consultants, such as endocrinologists and diabetes educators. Standards of Medical Care for Patients With Diabetes Mellitus. The responsibility of educating diabetic patients is often left to the nurses. Here are some medical interventions that are performed to manage diabetes mellitus. The presence of nephropathy is associated with retinopathy. (B), Laser therapy can reduce the risk of vision loss in patients with HRCs. Glucose does not In the nursing diagnosis, these complications must be taken to account. (B), Educate all patients, especially those with risk factors or prior lower-extremity complications, about the risk and prevention of foot problems and reinforce self-care behavior. a. Glucose is the only fuel used by the body to produce the energy that it needs. Comprehensive Medical Evaluation and Assessment of Comorbidities: 2. In Type 2 Diabetes Mellitus, the patient is making SOME insulin…However, one of two things is happening. 1.73 m−2 or if difficulties occur in the management of hypertension or hyperkalemia. (B), Patients with type 2 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist shortly after the diagnosis of diabetes. Women with diabetes who become pregnant should have a comprehensive eye examination in the first trimester and close follow-up throughout pregnancy and for 1 year postpartum. Patients are (A). The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. There is less evidence for lipid-lowering and aspirin therapy, although diabetes patients have such an elevated risk for CVD that aggressive management of lipids and aspirin use when not contraindicated are probably reasonable interventions. At the time of initial diagnosis, it is extremely important to establish the goals of care and to begin diabetes self-management education. Older patients can be treated with the same drug regimens as younger patients, but special care is required in prescribing and monitoring drug therapy. A healthy lifestyle, regular monitoring and taking medicines to keep your blood sugar (glucose), blood pressure and cholesterol levels as normal as possible are all very important. They should generally be discontinued in pregnancy. Evidence of increased pressure (erythema, hemorrhage under a callus). Lowering blood pressure, as shown in the UKPDS, has been shown to decrease the progression of retinopathy. Start studying Ch. Diabetes care for children of this age-group should be provided by a team that can deal with these special medical, educational, nutritional, and behavioral issues. d141713. Diabetes occurs in one of the following situations: The pancreas (an organ behind your stomach) produces little insulin or no insulin at all. Type 1 and 2 are the two types of diabetes mellitus. When the levels are below 70, the condition is considered hypoglycemia. specialized health care. In patients with clinically significant macular edema after 2 years, 20% of untreated eyes had a doubling of the visual angle (e.g., 20/50 to 20/100) compared with 8% of treated eyes. Not all of them apply to all patients, meaning the nurse needs to consider other factors such as the history of the disease, socioeconomic status, and the education level while designing the nursing diagnosis. jenlewis427; Subjects. In the unstable client, the priority of care is always airway, breathing, and circulation. (E). (A), The foot examination can be accomplished in a primary care setting and should include the use of a Semmes-Weinstein monofilament, tuning fork, palpation, and a visual examination. Normalize insulin activity. Because these interventions are generally provided as components of a multifactorial intervention, it is difficult to assess the contribution of each component; however, it is clear that optimal diabetes management requires an organized, systematic approach and involvement of a health care team. Care of the patient with HIV and other immune Deficiencies 6 Terms. People with diabetes may be at increased risk of the bacteremic form of pneumococcal infection and have been reported to have a high risk of nosocomial bacteremia, which has a mortality rate as high as 50%. This used to be called juvenile diabetes or juvenile onset diabetes, but they’ve found that it can actually develop later in life as well, so we stick to Type 1 or insulin-dependent. Chapter 67 Care of Patients with Diabetes Mellitus Margaret Elaine McLeod Learning Outcomes Safe and Effective Care Environment 1 Assess the person who has diabetes for specific current and ongoing factors that pose threats to safety. (E), Among the drugs commonly used in the treatment of patients with diabetes, statins are pregnancy category X and should be discontinued prior to conception if possible. 1. Safe and effective vaccines are available that can greatly reduce the risk of serious complications from these diseases (102,103). processes and hormonal actions are responsible. Therefore, the nurse's priority, together with that of the medical staff, is to ensure an adequate and patent airway, monitor vital signs and intervene as necessary. The risk of ulcers or amputations is increased in people who have had diabetes >10 years, are male, have poor glucose control, or have cardiovascular, retinal, or renal complications. Nutrition planning difficulties, fluid imbalance, sensation issues, and healing problems are some of the risk factors of this life-long disease. The preconception care programs were multidisciplinary and designed to train patients in diabetes self-management with diet, intensified insulin therapy, and SMBG. These three things (weight, diet, exercise) can help to manage or even reverse diabetes. managing their condition, evidence shows that patients with chronic illnesses techniques and tools. Chronic hyperglycemia can cause a catabolic state leading to malnutrition, functional impairment, and symptoms with decreased quality of life. C O M Chapter 64: Care of Patients with Diabetes Mellitus MULTIPLE CHOICE 1.A nurse is teaching a client with diabetes mellitus who asks, Why is it necessary to maintain my blood glucose levels no lower than about 60 mg/dL? Go to bed with satisfaction. A one-time revaccination is recommended for individuals >64 years of age previously immunized when they were <65 years of age if the vaccine was administered >5 years ago. Laser photocoagulation surgery in both the DRS and the ETDRS was beneficial in reducing the risk of further visual loss, but generally not beneficial in reversing already diminished acuity. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Specifically, K&B is poor with regard to self-foot examination, prompt treatment of foot problems, and regular foot inspection by professionals. Motivated patients educated about diabetes benefit the most from collaborating with a multidisciplinary patient-care team. The Centers for Disease Control’s Advisory Committee on Immunization Practices recommends influenza and pneumococcal vaccines for all persons over 65 years of age as well as for all persons of any age with diabetes. resistant. 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