1. Mrs.S, a housewife, 50 years old is admitted in I.C.U. with Diabetes Mellitus. She is a known case of Diabetes on irregular treatment. On admission her blood sugar level is 295.
(a) Discuss the pathophysiology of diabetes Mellitus.
(b) List down the complications of Diabetes Mellitus.
(c) Discuss in detail the nursing care of Mrs.S. applying nursing process.
Diabetes mellitus
Pathophysiology
Destruction of pancreatic beta cells
Due to a combination of genetic, immunologic and environmental factors
Autoimmune response in type I diabetes mellitus
Autoimmunity to islet cells and endogenous insulin
Lack of insulin action - glucose production by liver is uncontrolled
- storage form, glycogen is not produce enough leading to postprandial hyperglycemia
- renal threshold of 180 - 200 mg% exceeded - glycosuria
- excess glucose causes osmotic diuresis - polyuria, dehydration,
electrolyte loss
- fat breakdown occurs - ketone bodies produced - ketoacidosis
In type 2 diabetes - insulin resistance leads to decreased sensitivity of the tissues to insulin
Complications of diabetes mellitus
Acute Complications
3 major acute complications of diabetes related to short-term imbalances in blood glucose : -
hypoglycemia
diabetic ketoacidosis (DKA)
hyperglycemic hyperosmolar nonketotic syndrome (MHNS) also known as hyperglycemic hyperosmolar nonketotic coma
Long Term Complications
3 major categories of long term complications : -
Macrovascular disease
Microvascular disease
Neuropathy
renal disease
cardiovascular disease (myocardial infarction)
peripheral vascular disease,
cerebrovascualar disease (stroke),
peripheral arterial disease leading to intermittent claudication,
gangrene of toes, feet
diabetic retinopathy
diabetic nephropathy
diabetic neuropathy
Nursing care of Mrs.S
Blood sugar - 295 mg% - to be controlled with oral antidiabetics or insulin to a level of 150 to 180 mg %
Look for ketone bodies in the urine - start insulin therapy if ketoacidosis is present
Look for dehydraion and electrolyte imbalances and correct it
Educate her regarding the importance of glycemic control and the complications of uncontrolled DM, how to avoid insulin complications
Teach how to adjust food habits to achieve control of hyperglycemia (dietary prescription given)
Ask her to demonstrate the methods of self care taught to her during the previous visits : -
method of insulin loading and injection
foot care (especially if diabetic neuropathy is present)
Get her examined for retinopathy
Screen for nephropathy
