System Disorder: Diabetes Mellitus - Essay Example

System Disorder: Diabetes Mellitus

Alterations in health (Diagnosis)

Pathophysiology related to client problem

Health promotion and disease prevention

Diabetes mellitus is a hormonal disorder characterized by decreased insulin hormone production or increased resistance. Insulin is responsible for glucose uptake by cells. The effects of the disruption in the insulin hormone level in the blood are increased blood glucose levels, which has serious metabolic adverse effects, including metabolic acidosis (Barret et al., 2019).

There is a resultant glucose uptake by cells when inadequate amounts of insulin hormones are produced or when the receptors are resistant to insulin action (Barrett et al., 2019). When blood glucose concentration remains high for some time, the kidneys cannot reabsorb glucose anymore, so it is excreted in the urine. The resulting increased urine osmotic pressure prevents renal water reabsorption, which leads to polyuria, translating to massive fluid loss (Barrett et al., 2019). Through osmosis, fluid moves from the cells to the intravascular space to replace the lost blood fluid volume. This causes dehydration and feelings of excessive thirst (Barrett et al., 2019). The depletion of glucose within the cells also stimulates increased appetite.

From the patient's history, establish the duration and intensity of symptoms of dehydration. This will help estimate the amount of fluid depleted and inform the plan of care based on fluid therapy.

Monitor vital signs, particularly blood pressure and heart rate. This is to establish hypovolemia and manage it accordingly (Barrett et al., 2019).

Administer insulin injection to correct Kussmaul's respirations and acetone breath. These two are due to hyperglycemia ketoacidosis, which is part of the pathophysiologic processes in diabetes mellitus (Gulanick & Meyers, 2016).

Maintain daily fluid intake at 2500ml within cardiac tolerance levels, once the patient’s oral intake is okay (Gulanick & Meyers, 2016). This will prevent dehydration by maintaining the circulating fluid volume within the normal parameters.

Assessment

Risk factors

Laboratory findings

Diagnostic procedures

Expected findings

There are several risk factors for diabetes mellitus. First, excess weight predisposes one to high insulin resistance due to increased fatty tissues (Barret et al., 2019). Second, a family history of diabetes mellitus, particularly where there is insulin resistance, predisposes one to the condition (Barret et al., 2019). Inactivity and increase in age also predispose one to diabetes mellitus. This is attributed to the fact that more fatty tissue accumulates as one age due to inactivity (Barret et al., 2019).

The following elements are investigated when a blood sample is taken to the laboratory to establish diabetes mellitus: the random plasma glucose level, fasting plasma glucose level, and glycated hemoglobin levels.

Diagnostic tests are only necessary when assessing for the severity of complications of diabetes mellitus. The severity of complications such as diabetic nephropathy and neuropathy requires an ultrasound, MRI, or CT scan to establish. The extent of renal damage can also be established through renal scintigraphy or biopsy.

From the laboratory investigations (Barret et al., 2019), a random plasma glucose level of 11.1 mmol/L or more indicates diabetes mellitus. A fasting plasma glucose level of 7.0 mmol/L or more indicates diabetes mellitus. Glycated hemoglobin of 48 mmol/mol or 6.5% or more on two separate occasions also indicates diabetes mellitus.

An oral glucose tolerance test of more than 11.1 mmol/L also indicates diabetes mellitus.

The diagnostic tests will also reveal abnormalities in the respective areas under investigation.

Patient-centered care

Nursing care

Medications

Client education

Therapeutic procedures

Interprofessional care

Administer basal and prandial insulin to keep glucose levels within the normal range and prevent microvascular disease (Barrett et al., 2019).

Provide the patient with more nutritious fluids and electrolytes as soon as they can tolerate oral intake (Barrett et al., 2019).

Monitor the patient for signs of hypoglycemia and intervene accordingly.

Monitor blood glucose levels using fingerstick glucose testing.

Administer regular insulin.

Different classes of medications are administered depending on the patients. According to Waller and Sampson (2017), the medications administered include sulfonylureas such as glipizide and glyburide. The sulfonylureas increase insulin sensitivity and its secretion by the pancreatic cells. Biguanides are also common. A drug example in this class is metformin, which acts by increasing insulin sensitivity and decreasing the glucose amounts produced through gluconeogenesis.

Educate the client on self-monitoring of glucose levels so that the values can be used to modify insulin dosages accordingly (Gulanick & Myers, 2016). It is done before meals and before going to bed.

As a result of decreased peripheral sensations, patients are advised to avoid heating pads and instead always put on shoes (Gulanick & Myers, 2016).

Educate the client on the importance of sticking to the treatment regimen.

Educate the patient on maintaining the recommended dietary program as per their special needs (Gulanick & Myers, 2016).

Significant therapeutic procedures in diabetes mellitus include monitoring blood glucose levels, dietary management, psychosocial therapy for stress management, exercise regimen to keep weight under control, and monitoring medications (Barrett et al., 2019).

The collaboration of various healthcare teams is important in ensuring better health outcomes in a diabetic patient. The professional bodies involved are nutritionists and dietitians to assist in appropriate diet planning and monitoring the patient's nutritional status. Psychologists must also perform psychosocial counseling to individuals diagnosed with diabetes, as it is a terminal illness (Gulanick & Myers, 2016). Nurses’ and doctors’ efforts are arguably essential in the treatment and management of these patients.

Complications

Safety considerations

Without early diagnosis and prompt treatment, the pathophysiologic changes in diabetes mellitus could advance gradually into major complications. Most complications are related to damage to the peripheral nerves and the blood vessels (Gulanick & Myers, 2016). These include diabetic neuropathy, nephropathy, and retinopathy. Cardiovascular diseases such as coronary artery disease also develop due to damage to the blood vessels.

Due to decreased peripheral sensation, decreased immunity, and possible impaired vision, patients are at high risk of injury (Gulanick & Myers, 2016). Therefore, nurses should carefully assess the foot on every hospital visit for injury. Patients should be instructed to observe high standards of food hygiene and keep it moisturized using lotion. Maceration on the feet, particularly between the toes, predisposes the patient to infections (Gulanick & Myers, 2016). Patients should regularly inspect for cuts on the feet both visually and by touch so that if there is any, it should be managed promptly.

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