Melllitus Diabetes is a collection of symptoms that arise in a person caused by the presence of elevated levels of sugar (glucose) in the blood caused by a deficiency of insulin both absolute and relative
Classification of Diabetes Mellitus
Classification of diabetes mellitus as follows:
Type I: insulin-dependent diabetes mellitus (IDDM)
Type II: Diabetes mellitus is insulin dependent (NIDDM)
Diabetes mellitus is associated with other conditions or syndromes
Gestational diabetes mellitus (GDM)
Etiology of Diabetes Mellitus
Based on the clustering of diabetes is divided into two types namely:
Diabetes type I:
a. Genetic factors
Diabetics do not inherit type I diabetes itself, but inherit a genetic predisposition or tendency toward the occurrence of diabetes mellitus type I. Genetic predisposition is found in individuals who have HLA antigen type.
b. Immunological Factors
The existence of an autoimmune response in which antibodies directed an abnormal response to normal tissue reacts to the body in a way that considers the network as if they were foreign tissue. Ie autoantibodies against islet cells of Langerhans and endogenous insulin.
c. Environmental factors
Viruses or certain toxins can trigger autoimmune process that causes destruction selbeta.
Diabetes Type II
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:
a. Age (insulin resistance tends to increase in age above 65 years)
b. Obesity
c. Family history
Pathophysiology / Pathways Diabetes Mellitus
Pathophysiology of DM
Signs and Symptoms of Diabetes Mellitus
A common complaint of patients DM like polyuria, polydipsia, polyphagia in DM is generally no. Instead the patient is often disturbing complaints from complications of chronic degenerative blood vessels and nerves. In the elderly there is a change in the pathophysiology of DM due to the 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, tingling in the limbs and muscle weakness (peripheral neuropathy) and injuries to the legs which are difficult to recover with treatment prevalent.
According Supartondo, the symptoms caused by diabetes mellitus in the elderly are often found are:
1. Cataract
2. Glaucoma
3. Retinopathy
4. Itching around the body
5. Pruritus Vulvae
6. Bacterial infections of skin
7. Fungal infections in the skin
8. Dermatopati
9. Peripheral neuropathy
10. Visceral neuropathy
11. Amiotropi
12. Neurotrophic ulcer
13. Kidney disease
14. Peripheral vascular disease
15. Coronary Disease
16. Cerebral vascular disease
17. Hypertension
Osmotic diuresis due to glucosuria delayed due to high renal threshold, and can occur with nocturia complaints of sleep disturbance, or even urinary incontinence. Feelings of thirst in elderly diabetic patients are less felt, as a result they do not respond adequately to the dehydration. Because it does not happen polydipsia or just happened at an advanced stage.
The disease is initially mild and there was the usual course in elderly patients with DM can change suddenly, if the patient has an acute infection. Deficiency of insulin which had now become relative and absolute state of ketoacidosis occur 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 elderly DM. Usually appears manifest as sudden headache and confusion.
Vegetative reactions in the elderly may disappear. While the symptoms are confusion and coma of cerebral metabolic disturbances appear more clearly.
Examination Support Diabetes Mellitus
Blood glucose during
check GDS
Fasting blood glucose levels
Glucose tolerance test
Blood levels during fasting as a standard filter and the diagnosis of DM (mg / dl)
WHO diagnostic criteria for diabetes mellitus at least 2 times the examination:
1. When plasma glucose> 200 mg / dl (11.1 mmol / L)
2. Fasting plasma glucose> 140 mg / dl (7.8 mmol / L)
3. Plasma glucose from samples taken 2 hours later after consuming 75 g carbohydrate (2-hour post-prandial (pp)> 200 mg / dl
Management of Diabetes Mellitus
The main goal of therapy of diabetes mellitus is trying to normalize the activity of insulin and blood glucose levels in an attempt to reduce vascular complications, and neuropathy. Therapeutic purposes in any type of diabetes is to achieve normal blood glucose levels.
There are 5 components in the management of diabetes:
1. Diet
2. Exercise
3. Monitoring
4. Therapy (if needed)
5. Education
Nursing Assessment of Diabetes Mellitus
Family Health History
Are there families who suffer from diseases such as client?
Patient Medical History and Previous Treatment
How long a client suffering from diabetes, how to handle, gets what type of insulin therapy, how to take her medicine whether regular or not, what is being done to address the client's illness.
Activity / Rest:
Tired, weak, difficult Moving / walking, muscle cramps, decreased muscle tone.
Circulation
Is there a history of hypertension, AMI, claudication, numbness, tingling in the extremities, foot ulcers are healing old, tachycardia, changes in blood pressure
Ego Integrity
Stress, anxiety
Elimination
Changes in the pattern of urination (polyuria, nocturia, anuria), diarrhea
Food / fluid
Anorexia, nausea, vomiting, do not follow the diet, weight loss, thirst, use of diuretics.
Neurosensori
Dizziness, headache, tingling, numbness in the muscle weakness, paresthesias, visual disturbances.
Pain / Leisure
Abdomen tense, pain (moderate / severe)
Breathing
Cough with / without purulent sputum (tergangung presence of infection / no)
Security
Dry skin, itching, skin ulcers.
Nursing Problems in Diabetes Mellitus
High risk of nutritional deficiencies: lack of requirement
Lack of fluid volume
Impaired skin integrity
Risk of injury
Diabetes Mellitus Nursing Intervention
1. High risk of nutritional deficiencies: lack of demand associated with decreased oral input, anorexia, nausea, increased metabolism of protein, fat.
Goal: patient's nutritional needs are met
Criteria Results:
Patients can digest the amount of calories or the right nutrients
Stable weight or additions to the range normally
Intervention:
Weigh the body 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 presence of abdominal pain / abdominal bloating, nausea, vomit that have not had time to digest food, maintain a state of fasting according to the indication.
Give liquid foods that contain nutrients (nutrients) and electrolytes immediately if the patient is able to tolerate it orally.
Involve the patient's family at this meal digestion according to the indication.
Observed signs of hypoglycemia such as altered levels of consciousness, skin moist / cold, rapid pulse, hunger, sensitive excitatory, anxiety, headaches.
Collaboration perform blood sugar checks.
Collaboration of insulin treatment.
Collaboration with a dietitian.
2. Lack of fluid volume associated with osmotic diuresis
Purpose: fluid or hydration needs of patients are met
Criteria Results:
Patients showed adequate hydration evidenced by stable vital signs, palpable peripheral pulse, skin turgor and good capillary refill, individually appropriate haluaran urine and electrolyte levels within normal limits.
Intervention:
Monitor vital signs, note the presence of orthostatic BP changes
Monitor breathing patterns such as the respiratory kusmaul
Assess the frequency and quality of breathing, use of auxiliary respiratory muscles
Assess peripheral pulses, capillary refill, skin turgor and mucous membranes
Monitor input and expenditure
Keep up to provide fluid at least 2500 ml / day within a tolerable limit of cardiac
Record such things as nausea, vomiting and gastric distention.
Observations of increased fatigue, edema, increased weight, irregular pulse
Collaboration: give normal saline fluid therapy with or without dextrosa, monitor laboratory tests (hematocrit, BUN, Na, K)
3. Impaired skin integrity related to changes in metabolic status (peripheral neuropathy)
Objectives: impaired skin integrity can be reduced or showed healing.
Criteria Results:
Condition of the wound showed the existence of tissue repair and uninfected
Intervention:
Assess the wound, the presence of epithelialization, discoloration, edema, and discharge, the frequency of dressing change.
Assess vital signs
Assess the pain
Perform wound care
Collaboration administration of insulin and medication.
Collaboration antibiotics as indicated.
4. Risk of injury associated with decreased visual function
Objectives: patients do not experience injury
Criteria Results: The patients can meet their needs without suffering injury
Intervention:
Avoid slippery floors.
Use a low bed.
Orient the client to the room.
Assist client in performing daily activities
Assist patients in ambulation or position changes
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