NURSING IN DIABETES MELLITUS PATIENTS

NURSING IN DIABETES MELLITUS PATIENTS

Definition
Diabetes Mellitus is a collection of symptoms that arise in a person caused by an increase in blood sugar (glucose), blood due to insulin deficiency both absolute and relative terms (Arjatmo, 2002).

Diabetes mellitus is a heterogeneous group of disorders characterized by increased levels of glucose in the blood or hyperglycemia. (Brunner and Suddarth, 2002).


Classification
Classification of diabetes mellitus as follows:

Type I: insulin-dependent diabetes mellitus (IDDM)
Type II: Diabetes mellitus is independent of insulin (NIDDM)
Diabetes mellitus associated with other conditions or syndromes
Gestational diabetes mellitus (GDM)


Etiology

Diabetes Type I:
Genetic factors
People with diabetes do not inherit the type I diabetes itself, but inherit a genetic predisposition or a tendency toward the occurrence of diabetes mellitus type I. Genetic predisposition is found in individuals who have HLA antigen type.
Immunological Factors
The existence of autoimmune responses, which is an abnormal response in which antibodies directed at the normal tissues of the body by way of reacting to network which is considered as if in a foreign network. Namely autoantibody against the island of Langerhans cells and endogenous insulin.
Environmental factors
Viruses or certain toxins can trigger the autoimmune process that causes destruction selbeta.
Type II Diabetes
The exact mechanism that causes insulin resistance and impaired insulin secretion in type II diabetes is still unknown. Genetic factors play a role in the process of insulin resistance.
Risk factors:
Age (insulin resistance tended to increase at the age of 65 years)
Obesity
Family history


Signs and Symptoms
Common complaints such as diabetes mellitus patients polyuria, polydipsia, polifagia the DM generally do not exist. Instead of disturbing the patient is a complaint often from complications of chronic degenerative diseases of the blood vessels and nerves. In the elderly there are changes in the pathophysiology of DM due to aging process, so that the clinical picture varies from asymptomatic cases to cases with extensive complications. A recurring complaint is the presence of impaired vision due to cataracts, a sense of numbness in the limbs and muscle weakness (peripheral neuropathy) and wounds on limbs that are hard to heal with normal treatment.
According Supartondo, symptoms due to diabetes mellitus in the elderly are often found are:
1. Cataract
2. Glaucoma
3. Retinopathy
4. Itching all over body
5. Pruritus vulvae
6. Bacterial infection of skin
7. Fungal infections in the skin
8. Dermatopati
9. Peripheral neuropathy
10.Neuropati visceral
11.Amiotropi
12.Ulkus neurotrophic
13.Penyakit kidney
14.Penyakit peripheral vascular
15.Penyakit coronary
16.Penyakit brain blood vessels
17.Hipertensi

Osmotic diuresis due to glucosuria delayed due to a high renal threshold, and can appear along with nocturia complaints of sleep disturbance, or even incontinence of urine. Feelings of thirst in elderly diabetic patients is less felt, as a result they do not react adequately against dehydration. Because it does not occur or new polydipsia occurs at an advanced stage.
The disease is initially mild and the usual mediocrity found in elderly diabetic patients can change suddenly, when patients had acute infection. Insulin deficiency that had now become an absolute relative and circumstances arise ketoacidosis with typical symptoms of hyperventilation and dehydration, decreased consciousness with hyperglycemia, dehydration and ketonemia. Symptoms usually occur in hypoglycemia such as hunger, yawning and sweating a lot is generally not present in the elderly diabetic. Usually appears manifest as sudden headache and confusion.
Vegetative reactions in the elderly may disappear. While symptoms of confusion and coma which is a disorder of cerebral metabolism appear more clearly.


Examination Support

Blood glucose during
Fasting blood glucose levels
Glucose tolerance test
When blood levels and fasting as a benchmark filter DM diagnosis (mg / dl).

Blood glucose levels during

Venous plasma:
<100>
100-200 = uncertain DM
> 200 = DM
Capillary blood:
<80>
80-100 = uncertain DM
> 200 = DM

Fasting blood glucose levels

Venous plasma:
<110>
110-120 = DM uncertain
> 120 = DM
Capillary blood:
<90>
90-110 = uncertain DM
> 110 = DM


WHO diagnostic criteria for diabetes mellitus at least 2 times the examination:

While plasma glucose> 200 mg / dl (11.1 mmol / L)
Fasting plasma glucose> 140 mg / dl (7.8 mmol / L)
Plasma glucose from samples taken 2 hours later after consuming 75 g carbohydrate (2 hours post prandial (pp)> 200 mg / dl).


Management
The main purpose of treatment of diabetes mellitus is trying to normalize the activity of insulin and blood glucose levels in an effort to reduce vascular complications and neuropathy. Therapeutic goal in each type of diabetes is to achieve normal blood glucose levels.
There are 5 components in the management of diabetes:

Diet
Exercise
Monitoring
Therapy (if needed)
Education

Assessment

Family Health History
Are there families who suffer from diseases such as client?
Patient Medical History and Prior Treatment
How long a client suffering from diabetes, how to handle, gets what kind of insulin therapy, how to take her medicine whether regular or not, what is being done to tackle the disease clients.
Activity / Rest:
Tired, weak, Difficult Moves / walking, muscle cramps, decreased muscle tone.
Circulation
Is there a history of hypertension, AMI, klaudikasi, numbness, tingling in the extremities, ulcers on the feet that long healing, tachycardia, changes in blood pressure
Ego Integrity
Stress, anxiety
Elimination
Changes in the pattern of urination (polyuria, nocturia, anuria), diarrhea
Food / Fluids
Anorexia, nausea, vomiting, do not follow the diet, weight loss, thirst, the use of diuretics.
Neurosensori
Dizziness, headache, tingling, numbness in muscle weakness, paresthesias, visual disturbances.
Pain / Leisure
Abdomen tense, pain (moderate / severe)
Respiratory
Cough with or without purulent sputum (tergangung an infection / no)
Security
Dry skin, itching, skin ulcer.


Nursing Issues

High risk of nutritional deficiencies: lack of demand
Lack of fluid volume
Impaired skin integrity
Risk of injury


Intervention

High risk of nutritional deficiencies: lack of demand associated with decreased oral input, anorexia, nausea, increased metabolism of protein, fat.
Objective: The patient's nutritional needs are met
Criteria Results:
Patients can digest the amount of calories or nutrients appropriate
Stable weight or additions to the range usually
Intervention:

Weigh weight per day or according to the indication.
Determine the diet and eating patterns of patients and compare it with foods that can be spent on patients.
Auscultation bowel sounds, record the existence of abdominal pain / abdominal bloating, nausea, vomit that has not had time to digest food, maintain a state of fasting according to the indication.
Give a liquid diet containing foods (nutrients) and the electrolyte immediately if the patient has to tolerate it orally.
Involve the patient's family at this meal digestion according to the indication.
Observation of the signs of hypoglycemia, such as changes in level of consciousness, skin moist / cold, rapid pulse, hunger, sensitive stimuli, anxiety, headaches.
Collaboration examination of blood sugar.
Collaboration of insulin treatment.
Collaboration with a dietitian.

Lack of fluid volume associated with osmotic diuresis.
Objective: The need for fluids or hydration of patients fulfilled
Criteria Results:
Patients showed an adequate hydration evidenced by stable vital signs, peripheral pulse can be felt, skin turgor and capillary filling good, accurate urine output individually and electrolyte levels within normal limits.
Intervention:

Monitor vital signs, note the change of orthostatic BP
Monitor breathing patterns such as the respiratory kusmaul
Assess the frequency and quality of breathing, use of auxiliary respiratory muscles
Assess peripheral pulse, capillary filling, skin turgor and mucous membranes
Monitor input and expenditure
Preserve to provide fluid at least 2500 ml / day within the limits that can be tolerated heart
Record such things as nausea, vomiting and stomach distention.
Observation of increased fatigue, edema, increased weight, irregular pulse
Collaboration: give normal saline fluid therapy with or without dextrosa, monitor laboratory (Ht, BUN, Na, K).

Impaired skin integrity related to changes in metabolic status (peripheral neuropathy).
Objective: to reduce disturbance of skin integrity or indicate healing.
Criteria Results:
The condition of the wound showed an improvement and uninfected tissue
Intervention:

Assess the wound, the epithelialization, discoloration, edema, and discharge, the frequency of dressing change.
Assess vital signs
Review of pain
Perform wound care
Collaboration of insulin and medication.
Collaboration antibiotics as indicated.

Risk of injury associated with decreased visual function
Objective: The patient did not experience injury
Criteria Results: The patient can meet its needs without experiencing injury
Intervention:

Avoid slippery floors.
Use a low bed.
Orient clients to the room.
Assist clients in performing daily activities
Assist patients in ambulation or position changes.

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