Advanced Theoretical concepts in Nursing. Diabetes Mellitus Type-II By Talat Rashid December 12, 2007. Objectives. Define the disease in the case study Discuss the prevalence, significance of Diabetes Mellitus type II.(DM II)
Advanced Theoretical concepts in Nursing
Diabetes Mellitus Type-II
December 12, 2007
- Sense of heaviness over lower
- Retention of urine
- Excessive urination (Polyuria)
- Excessive thirst (Polydipsia)
- Excessive eating (Polyphagia)
- Becomes angry on minor issues
DM (-), HTN (+), Cardiac dis (+)
Businessman, normal sleep, Appetite,
feels has lost wt from 01 yr., smoking
from last 10 yrs
BMI = Wt (kgs) / Ht (mxm)
= 85 kgs /1.8m x1.8m
= 85 / 3.24
= 26.23kgs/m2 (n.range= 19-24kgs/m2)
Skin: inspection for breakdown, non healing pustules,
diabetic ulcer or wound, Diabetic foot.
Neurological system: Sensory & motor system. Paralysis, Balance,
response to pain & sensitization of hot or cold application over
limbs for parasthesia to rule out Diabetic Neuropathy,
Cognition status: orientation, alertness, memory status.
Eyes: vision, pain, cataracts, fundoscopy to rule out Diabetic
Mouth: inspection of gums & teeth for infection, buccal mucosa for
CVS: pain, palpitation, heart sounds, dysnea, murmurs,,HTN
PVS: varicose veins, thrombophlebitis, leg cramps
Genito-urinary: frequency of micturation, pressure symtoms, burning
micturation, incontinence of urine, Diabetic Nephropathy
Musculoskeletal system : ROMs, strength, gait & balance
Endocrine : Goiter, change in weight, polyphagia, polidypsia,
T. Cholesterol 201 mg/dl (Nor < 250)
Triglycerides 104 mg/dl (Nor < 150)
HDL 40 mg/dl (Nor > 40)
LDL 143 mg/dl (Nor > 100)
(Non Insulin Dependant Diabetes Mellitus)
HOSPITAL / TERTIARY CARE
HOSPITAL WORKLOAD / NOSOCOMIAL INFECTIONS
HEALTHY AND PRODUCTIVE COMMUNITY
(Report of a WHO Meeting, 2004 )
20.8 million (7 % population) had diabetes in 2005,
6.2 million of them undiagnosed. 90 to 95 % (18.7 million - 19.8 million people) of Diabetics had type 2 diabetes.
(U.S. National Institutes of Health-2006)
The prevalence rate of diabetes 16.2% (9% known and 7.2% newly diagnosed) in men and 11.7% (6.3% known and 5.3% newly diagnosed) in women. The prevalence increased to almost 30% and 21% in 65-74 years old men and women respectively. 79% of Diabetic men & 96% of Diabetic womenin Pakistan are obese.
Traditionally thought to affect > 40 years
However, Incidence increasing in younger persons, in prepubertal children, teenagers, and young adults.
Type 2 diabetes mellitus is observed even in some obese children.
End product of CHO
Insulin is released
Glucose in the blood
Movement of glucose to
body’s muscle, fat & liver cells
Glucose used by the body
as FUEL for ENERGY
Production of Insulin (Auto immune) Insulin resistance
by liver, fat & muscle cells
Ineffective movement of Glucose to the cell
no energy available to cells
Blood Levels of Glucose
Coronary, peripheral- vascular, diabetic nephropathy associated with BP & albumin in the urine (detected by urinalysis) kidney failure
Polydypsia (Increased thirst)
Polyuria (Increased urination)
Polyphagia (Increased appetite)
*Tab Amaryl Img Bid
*Tab Glucobay 50mg BD
Tab Diabenese 100mg, 250mg
Tab Metformin 500mg OD
Tab Glucophage 500mg OD
*Tab Esso 40 mg OD
*Tab Ascard 70 mg OD
-Watch for hypoglycemia (cautiously used in elderly & malnourished)
-Drug should be taken with first meal of the day
-Watch for hypoglycemia
-Contraindicated in inflammatory bowel disease, colonic ulceration, predispositon to intestinal obstruction.
- Use cautiously in pts with GI lesions, impaired renal function, Vit k deficiency, bleeding disorders.
-Should be discontinued , if bleeding from any sight occurs & 7 days prior surgery
- Pt taught to take drug with food
Research in the proposed treatment of type II diabetes :
Integration of Theory in patient with DM
“Bandura’s Self-Efficacy Theory”
(Graham & Winner, 1996)
Self- monitoring of
Compliance with Rx
Follow Dietary restriction.
Regular follow ups in cc.
Health outcome (improved health)
HEALH CARE PROGRAMS
Develop habits of
willingness to do
-Control on weight through a weight reduction program and exercise. Use of stairs instead of elevators, and a regular program of walk, starting from small distance to gradually increasing the distance.
-Reduction of calories in diet. Limit fat intake to about 25 percent of total calories. For example, if the food choices add up to about 2,000 calories a day, should eat no more than 56 grams of fat.
-Diet can be planed with the dietition. The patient can be asked to check food labels for fat content too.
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