endocrine 3a part 3. long term complications of diabetes macro vascular complications –...
TRANSCRIPT
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Endocrine 3A
Part 3
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Long Term Complications of Diabetes
• Macro vascular complications– Arteriosclerosis
• Characterized by thickening and loss of elasticity of the arterial walls “hardening of the arteries”.
– Coronary Artery Disease– Cerebrovascular Disease– Peripheral vascular disease
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Coronary/cerebrovascular disease
Changeable risk factors• Weight control• Low-fat diet• Treat hypertension• Treat hyperlipidema• Regular exercise• Control blood glucose levels• Smoking• Diabetes
Unchangeable risk factors• Age• Gender• Family history• Race
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Microvascular complications
• Characterized by basement membrane thickening
• Effects smallest blood vessels• Due to hyperglycemia
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Diabetic Retinopathy
• Damage to the tiny blood vessels that supply the eye
• Small hemorrhages occur
• Damage is due to hyperglycemia
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Prevention
• Control– Glucose– BP
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Prevention
• No straining• Use laxatives• Avoid lowering head• Avoid lifting above
shoulders
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Retinopathy: Medical Management
• Photocoagulation “laser” treatment
• Control hypertension• Control blood glucose• No smoking
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Retinopathy: Nursing Considerations
• Expected• Odds are good• Frequent eye exams• Bilateral but uneven
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Other Optic Complications
• Cataracts• Lens Changes• Extraocular muscle
palsy• Glaucoma
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Nephropathy
• Damage to the tiny blood vessels within the kidney.
• Due to– Hyperglycemia
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Nephropathy: Etiology
• glucose levels– Stress kidney’s
filtration mechanism
• Blood protein leaks into urine
• Pressure in blood vessel of kidney
• Kidney failure
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Nephropathy: Pathophysiology
Normally• Kidneys filter blood• Small molecules & waste
squeeze through kidneys urine
• Big stuff (I.e. protein, RBC), stay in blood where they belong
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Nephropathy: Pathophysiology
• Diabetes damages the system
• Filters start to leak• Protein and RBC lost in
urine– Microalbuminuria– Macroalbuminuria– Proteinuria
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Nephropathy: Pathophysiology
• Filters collapse• Lose of filtering ability– Kidney failure– ESRF / ENRD
• Waste products build up in blood
• Dialysis • Kidney transplant
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Nephropathy: S&S / Dx
• Proteinuria / albuminuria
• urine output• Edema• BUN & Creatinine ↑• BP
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Nephropathy:Prevention
• Control BG• Control HTN• Tx UTI• No nephrotoxic
substances• Na• Protein
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Nephropathy:Management
• Tight glucose control• Anti-hypertensives– Calcium-channel
blockers– Alpha blockers– ACE inhibitor
• Dialysis• Transplant
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Neuropathy
• Damage to the Nerves due to hyperglycemia• Most common complication• Various Types of Neuropathies…
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Neuropathy
• Sensory-Motor Polyneuropathy– AKA peripheral
neuropathy– Paresthesias: primarily
lower extremities– deep tendon reflexes
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Neuropathy
Sensory-motor Numb feet proprioception sensation Unsteady gait risk foot injury
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Neuropathy: Management
• Control serum glucose levels
• Pain control– Analgesics (non-
narcotic)– Tri-cyclic
antidepressants– Anticonvulsants
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Neuropathy:
• Autonomic neuropathy– Autonomic NS– Can affect almost any
system
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Autonomic Neuropathy
• Cardiovascular– Tachycardia– Orthostatic
hypotension– MI
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Autonomic Neuropathy
• Gastro-intestinal– Delayed gastric
emptying– Constipation– Diarrhea
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Autonomic Neuropathy
• Urinary– Retention– Neurogenic bladder
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Autonomic Neuropathy
• Reproductive– Male impotence
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Autonomic Neuropathy
• Adrenal Gland– “Hypoglycemic
Unawareness”– Adrenal Medulla– Adrenergic symptoms– No longer feel S&S– Strict BG control &
frequent monitoring
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Autonomic Neuropathy
• Sudomotor neuropathy– No sweating– Anhidrosis– dry feet– foot ulcers
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Infections
• High risk of foot infections– Neuropathy
• Pain sensation–
• Pressure sensation–
• Dryness–
• Fissures–
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Infections
• Peripheral vascular disease– Circulation
• – WBC
• – Oxygen
• – wound healing
• Poor– Antibiotics
• – Gangrene
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Infections
• Immuno-compromised– WBC + hyperglycemia =
sluggish WBC’s
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Infections
• Once they occur difficult to treat– Poor circulation– Antibiotic not get there– Sluggish WBC’s– Unknown wounds
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Infections
• Particular concern– Foot
infections/wounds
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Boils: AKA: "furuncles" round, pus-filled
bumps on the skin
D/T: Staphylococcus aureus bacteria
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Cellulites• noncontagious
inflammation of the connective tissue of the skin,
• D/T bacterial infection
• Treatment– Antibiotics – Analgesics
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Infections of concern
• UTI’s• Yeast Infections• Periodontal disease
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Infections of concern
Gangrene• term to describe the
decay or death of an organ or tissue
• d/t blood supply.
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Infections of concern (FYI)
• Necrotizing fasciitis – Flesh eating disease
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High risk for foot infections
• Duration of diabetes• Age• Smoking• Peripheral pulses• Sensation• Deformities/pressure
areas• Hx of foot ulcers
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Progression of events
• Soft tissue injury • Injury not sensed • Infection • Drainage, swelling,
redness • Gangrene
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Management of infections
• Bed rest• Antibiotics – Topic vs. IV
• Debridement• Control Glucose levels• ? Amputation
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Nursing Management
• Teach foot care– prevention
• Teach wound care
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Guideline to Healthy Feet
• Wash daily– Dry between toes– Lubricate dry feet
• Inspect – Mirror– Family– Between toes
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Guideline to Healthy Feet
• Avoid activities that circulation– Smoking– Crossing legs– Tight socks
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Guideline to Healthy Feet
• Good shoes– Comfortable– Closed toe– No bare feet– New shoes
• Break in slowly
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Guideline to Healthy Feet
• Prevent injuries– Wear socks
• Cotton• Light color• No wrinkles
– Check inside of shoe
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Guideline to Healthy Feet
• No temperature extremes– Check bath water– No water bottles– No heating pads
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Guideline to Healthy Feet
• See doctor regularly– Podiatrist– Trim straight across– Do not cut calluses or
corns
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Guideline to Healthy Feet
• Range of Motion
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Diabetics & Surgery
BS levels _____ during stress, surgery & illness–
If not controlled (BG) osmotic diuresis dehydration
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Diabetics & Surgery
• Risk of _________ if give shot of NPH and then NO surgery or surgery delayed– Hypoglycemia
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Diabetics & Surgery
• Management– Check BS before
surgery– No sub-Q– IV
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Hospitalized diabetic
• Independence• Sliding scale• Diets– NPO
• Still need insulin
– Clear liquids• Most simple carbs• Low sugar if possible
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NCLEX Question
Peripheral vascular disease is most common in patients with
A.an aneurysm.B.viral pneumonia.C.leukemia.D.diabetes mellitus.
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NCLEX Question
The nurse is reinforcing the importance of proper foot care to the elderly diabetic. The woman states that they surely must have something more important to discuss. The nurse correctly replies:
A. “Foot care as well as any other type of hygiene is always important.”
B. “We can skip this if you prefer.”C. “All right, just remember that you will be more prone to foot
odor.”D. “Diabetics can easily develop severe foot injury or infection
without knowing it.”