Professional Documents
Culture Documents
INTRODUCTION
When choosing a chronic health disorder I chose to
research Diabetes Mellitus. I chose diabetes because of
the enormous impact it is having on the Australian
population now and will have in the future. Some of the
startling facts that bought my attention to Diabetes are
that
PATHOPHYSIOLOGY
Type 1
Although Type 1 “Generally occurs to people under 30 it
can occur at any age. It makes up approx 10% of
people with Diabetes”5 .This is where the pancreas
produces little or no insulin which has been a gradual
destruction of the beta cells in the islets if langerhans in
the pancreas. This destruction is secondary to an
autoimmune response or virus in the body. Other
causes may be hereditary and stress. This destruction
occurs years prior to diagnosis . “The person will only
manifest signs and symptoms where there is a 15% or
less reduction of secretion of insulin function present”6
Type 2
“Generally occurs to people over 30 although it is
increasingly being seen in young adults and accounts
for approximately 90% of people with Diabetes”7 The
pancreas is able to produce insulin although it is usually
inefficient/ineffective to meet the bodies’ needs or is
poorly utilized. Type 2 Diabetes is usually seen in obese
adults or adults with hypertension and can itially be
treated with diet and exercise and not always but also
with oral hypogylcaemics. As the disease progress’s
some patients may have to eventually use insulin to
treat the disease
Sam Penny TR 13
CLINICAL MANIFESTATIONS
SHORT TERM
HYPOGLYCAEMIA
“Hypo’s occur when blood sugar levels are less then
3.5mmol/l”8 and are caused by, skipping meals, eating
foods low in carbohydrates, not eating enough before
exercise and too much insulin. The Diabetic client will
present with symptoms as follows,
• Sweating
• Headache
• Shaking
• Dizziness
• Pale pallor
• Tired
• Hungry
Then followed by
• Confusion
• Change in behaviour
• Slurred speech
• May appear drunk
HYPERGLYCAEMIA
“Is defined as three successive blood glucose levels
above 16mmol/l”9 As Michelle McAllister states in her
power point presentation this can be caused by, illness,
inactivity, weight gain, stress not enough medication
and hormonal changes. The Diabetic client will present
with symptoms as follows,
• Tiredness
• Thirst
• Frequent passing of urine
• Blurred vision
• Itchiness
• Leg cramps
Sam Penny TR 13
LONG TERM
NEUROPATHY
“A disease process of nerve degeneration and loss of
function”10 The patient will typically have pain,
numbness and loss of sensation particularly in the feet.
This is why daily inspection of the feet is so important.
A mirror can be utilized for the client to get an accurate
assessment of the condition of the soles of there feet.
RETINOPATHY
“A disorder of the retinal blood vessels characterised by
haemorrhages and leakage of blood and serum into the
retina”11 This leakage “decrease or block the blood flow
within the retina”12Retinopathy is also the leading cause
of adult blindness.
NEPHROPATHY
Completely painless damage to the kidneys which can
lead to chronic renal failure and eventually require
dialysis. Diabetes and hypertension are the most
common cause and the leading cause of kidney
transplant. “Preventing and treating any condition that
may impair renal function such as urinary tract
infection’s or hypertension reduce the development of
diabetic nephropathy”13
Sam Penny TR 13
NURSING INTERVENTIONS
INTERVENTION
RATIONALE
Type 2 Diabetes accounts for approximately 90% of
people with Diabetes. Type 2 Diabetes main risk factors
are obesity and a sedentary lifestyle so monitoring
weight will alert the client when they are within the
healthy weight range for there age group or when they
are drifting outside those ranges. This is also an
opportune time to discuss eating habits as diet and
weight are closely linked along with exercise. The nurse
can guide the client as to the foods to stay away from ie
saturated fats, sugars and high GI foods. The nurse can
also refer to appropriate allied health team member like
dietien for healthy eating and physio for exercise.
INTERVENTION
RATIONALE
Diet
I would explain the importance of diet in controlling
Blood Glucose Levels. Also explain the importance of
regular healthy meals with nutritious snacks high in
fibre with a low G I index foods low in fats and sugar
and reduction of alcohol intake. I would also explain the
importance of eating a wide variety of nutritious foods
including plenty of fruits and vegetables.
Carbohydrates are also important for long term energy
especially before exercise to prevent a hypoglycaemic
attack from occurring.
Sam Penny TR 13
EXERCISE
Because obesity and Diabetes go hand in hand
exercise is extremely important as it also “stimulates
the uptake of of glucose by muscle cells lowering blood
glucose levels and increasing the absorption of injected
insulin”16 But this can lead to hypoglycaemia so extra
nutritional intake prior to exercise is important.
MEDICATION
As with all medication I would explain to take exactly
as directed from their treating Dr. I would explain to my
client why they are either on oral hypoglycaemics or
insulin. I would explain the importance of compliance
with medication to reduce the likelihood of future
complications due to elevated blood sugars. If my client
were to need insulin I would explain the correct
injecting technique and ask the client to show me them
administering insulin themselves to ensure safe and
correct. I would explain the importance of rotating the
site and that the abdomen followed by the thighs are
the best place for absorption of injected insulin.
Sam Penny TR 13
REFERENCES
10.King,J.,Hawley,R.,Weller,B (2008)
Pg 312 Australian Nurses’ Dictionary 4th Edition
Baillere Tindall
13.Funneell,R.,Koutouludis,G.,Lawrence,K (2009)
Pg 714 Paragraph 4 Tabbner’s Nursing Care 4th Edition
Theory and Practice. Churchill Livingstone Edinburgh
15.Funneell,R.,Koutouludis,G.,Lawrence,K (2009)
Pg 714 Paragraph 7 Tabbner’s Nursing Care 4th Edition
Theory and Practise. Chuchill Livingstone Edinburgh
16.Funneell,R.,Koutouludis,G.,Lawrence,K (2006)
Pg 112 Paragraph 5 Tabbners’ Nursing Care 4th Edition
Theory and Practise. Churchill Livingstone Edinburgh
Sam Penny TR 13