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)
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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 :
“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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- ‘Diabetic diet information, what should you
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Self-Efficacy’, retrieved from www.healthology.com
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health states (7th ed.). New York: Lippincott.