糖尿?。ㄈ⑽陌妫〥iabetesMellitus

1、整理pptDiabetes Mellitus 整理pptTeaching objectives grasp the definition and types of diabetes mellitus realize etiology and pathogenesis realize diagnosis and classification grasp the clinical manifestation for the patient with diabetes mellitus be aware of the main lab examination realize the treatmen

2、t for the patient with diabetes mellitus整理pptIntroduction There are more and more people suffer from diabetes with the development of society, population aging and changes of life style. 整理pptDiabetes mellitus is a group of metabolic disorders characterized by chronic hyperglycemia which results fro

3、m the defects of insulin secretion or function, or both.整理pptLong-standing diabetes may lead to multisystem damage such as eye, kidney, nerve, heart, blood vessels and so on.整理pptEtiology Etiology and pathology are complex, and still unknown. But it is a syndrome results from compound etiological fa

4、ctor and has relation to inheritance, autoimmune and environment. 整理pptFactors associated with diabetes include obesity, aging, and ethnic group. 整理pptClassificationnType 1 diabetesuStage 1: genetics emotivityuStage 2: start autoimmuneuStage 3: immunology abnormality 整理pptuStage 4: progressive dysfu

5、nction of beta cellsuStage 5: clinical diabetesuStage 6: beta cells of the clients who have longtime diabetes are damaged thoroughly, blood insulin level is very low整理pptnType 2 diabetesugenetics emotivityuhyperinsulinism and (or) insulin resistanceuimpaired glucose tolerance (IGT)uclinical diabetes

6、 整理pptnOther types uinclude beta cell genetic defects, endocrinopathies, and drug or chemical-induced diabetesugestational diabetes mellitus整理pptClinical manifestation nMetabolic disorders syndrome: polyuria, polydipsia, polyphagia and weight loss整理pptnAcute complications of diabetes: DKA, hyperosmo

7、lar nonketotic diabetic coma, infection整理pptDKA u evocation factors surgery, stress, infection, deficiency of insulin dosage, pregnancy, delivery, anesthesia, or illness may trigger DKA整理pptuClinical featuresClassic symptoms of hyperglycemia (polyuria, polyphagia, polydipsia) precede DKA. Other symp

8、toms: nausea, vomiting, abdominal pain, headache, weakness, fatigue, hyperpnea整理pptuLab test Laboratory values will reveal blood glucose from 300 to 600 mg/dl(16.7-33.3mmol/l), and metabolic acidosis. Urine will be positive for glucose and ketones.整理ppthyperosmolar nonketotic diabetic comauevocation

9、 factors include illness or other stressor such as infection, cerebrovascular events, or some drugs.整理pptuClinical features lethargy, illusion, disorientation, seizure and coma.整理pptuLab test blood glucose is higher than 33.3 mmol/l, usually 33.3-66.6 mmol/l and serum osmolality 350 mmol/l整理pptinfec

10、tionuSkin infection, septicaemia, pulmonary tuberculosis,infection of urinary system整理pptnChronic complications of diabetes: cardiovascular diseases, nephropathy, diabetic neuropathy, retinopathy, diabetic foot infection整理pptCardiovascular diseases pain, paresthesia of lower extremeties and intermit

11、tent claudication heart failure, arrhythmia, cardiogenic shock,and sudden death整理pptNephropathy nephrosclerosis edema, proteinuria, hypertension整理pptdiabetic neuropathy numbness, pain and paresthesia of extremeties, muscular atrophy整理pptretinopathy : microangiopathydiabetic foot infection: gangrenou

12、s 整理ppt整理ppt整理pptLab test nurine glucose nblood glucose nIGT整理pptTreatment nDiet maintain as near-normal blood glucose level as possible, achieve optimal serum lipid levels, provide adequate energy.整理pptnActivity: aerobic exercisenOral glucose-lowering agents: sulfonylurea, biguanides, glucosidasenI

13、nsulin therapy 整理pptInsulin Therapy noticeadminister insulin as ordered, inject insulin on time with correct type and precise dosagetime, position and method of injectionside effects of insulin therapy: hypoglycemia, insulin allergy, subcutaneous fat atrophy or proliferation整理pptnTransplantation of

14、pancreas and islet nTreatment for gestational diabetes nTreatment for DKA : intravenous infusion, insulin therapy, keep balance of electrolyte and acid-base, prevent and manage complicationsnHyperosmolar nonketotic diabetic coma整理pptNursing process nAssessment uSubjective datauObjective data整理ppt Nu

15、rsing diagnosis 1: Deficient Knowledge: Diabetes, medical regimen, diet, exercise, self-care management skills (insulin injection, SMBG) related to new diagnosis or changes in treatment Nursing diagnosis 2: Imbalanced Nutrition: Less than body requirements related to imbalance between insulin, diet, an